Menstrual Disorders

Question 1

What is Amenorrhea?

Answer 1

Absence of menses

Question 2

What is primary amenorrhea?

Answer 2

Absence of menarche (first menses) by age 15 despite normal growth and secondary sexual development

Absence of menarche by age 13 in absence of normal growth or secondary sexual development

Question 3

What is Secondary amenorrhea?

Answer 3

Absence of menses for more than 3 months (previously regular cycles), or 6 months (previously irregular cycles) in women who were previously menstruating

Question 4

Etiologies behind Primary Amenorrhea?

Answer 4

***Chromosomal abnormality causing gonadal dysgenesis (MOST COMMON)

Hypothalamic hypogonadism

Absence of the uterus, cervix and/or vagina, mullerian agenesis

Transverse vaginal septum or imperforate hymen

Pituitary disease

Question 5

What happens in Tuner’s syndrome?

Answer 5

(45, XO)

Results in premature depletion of oocytes and follicles
Associated with short stature, widely spaced nipples, webbed neck, and sexual infantilism

Question 6

What causes polycystic ovary syndrome

Answer 6

usually secondary amenorrhea

Question 7

How does Hypogonadotrophic hypogonadism cause Primary Amenorrhea?

Answer 7

Dysfunction with:

• GnRH transport
• GnRH pulse discharge
• Congenital absence of GnRH

Question 8

Disorders of HHP

Answer 8

slide 8

Question 9

slide 9

Answer 9

9

Question 10

How does Androgen Insensitivity Syndrome cause Primary Amenorrhea?

Answer 10

absent upper vagina, uterus and fallopian tubes on physical exam and pelvic ultrasound; high serum testosterone concentrations; and male (46,XY) karyotype

Question 11

flow chart on slide 11

Answer 11

11

Question 12

What is the first test you should order if someone comes in with supsected amenorrhea?

Answer 12

PREGNANCY
PRAGNANCY
PRAGNANCY