Anovulation and Amenorrhea 1

Question 1

What is the definition of primary vs. secondary amenorrhea vs. anovulation?

Answer 1

• Primary amenorrhea
  
  • no menses by age 16
  • no breast development by age 14
• Secondary amenorrhea
  
  • no menses for 6 months
• Anovulation
  
  • amenorrhea
  • oligomenorrhea
  • dysfunctional uterine bleeding

Question 2

What are the common presentations of anovulation?

Answer 2

• Amenorrhea
  
  • menses at > six month intervals
• Oligomenorrhea
  
  • menses at > 35 days to six month intervals
• Abnormal uterine bleeding
  
  • irregular, unpredictable, and sometimes heavy vaginal bleeding

Question 3

What are some common causes of secondary amenorrhea?

Answer 3

• Pregnancy - most common
• Regular breast feeding
• Contraception
  
  • oral contraceptive pill
  • progestin-only pill
  • progestin injections
  • implants or IUDs
  • due to endometrial atrophy
    *

Question 4

What are some common causes of hypothalamic-induced amenorrhea?

Answer 4

• Weight loss
• Stress
• Exercise
• Tumor
• Infiltrative disease
• Congenital hypogonadotropic hypogonadism (Kallmann’s syndrome for example)
• Constitutional delay of puberty

Question 5

What are some common causes of pituitary-induced amenorrhea?

Answer 5

• Hyperprolactinemia
• non-prolactin secreting tumor
• Sheehan’s syndrome
• GnRH receptor gene mutation
• LH-beta mutation
• FSH-beta mutation

Question 6

What are some common causes of ovary-induced amenorrhea?

Answer 6

• Premature ovarian failure with normal chromosomes
• Premature ovarian failure with abnormal chromosomes
• PCOS
• Androgen secreting tumors
• Galactosemia
• LH receptor mutation
• FSH receptor mutation
• Congenital adrenal lipoid hyperplasia
• 3-beta-hydroxysteroid dehydrogenase deficiency
• 17-hydroxylase/17,20-lyase deficiency
• Aromatase deficiency

Question 7

What are some common causes of uterus/outflow tract-induced amenorrhea?

Answer 7

• Asherman’s syndrome
• Androgen receptor mutation (androgen insensitvity syndrome)
• Uterine and vaginal aplasia (Rokitansky-Kuster-Hauser syndrome)
• Transverse vaginal septum
• Imperforate hymen

Question 8

What adrenal disroders will cause amenorrhea?

Answer 8

• Congential adrenal lipoid hyperplasia
• 21-hydroxylase deficiency
• 11-hydroxylase deficiency
• 3-beta-hydroxysteroid dehydrogenase deficiency
• Cushing’s syndrome
• 17-hydroxylase/17,20-lyase deficiency

Question 9

What are some thyroid disorders that will cause amenorrhea?

Answer 9

• Hypothyroidism
• Hyperthyroidism