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1

definition


For amenorrhea Refers to the lack of menstrual flow in the period of sexual maturity. So, between
menarche and menopause, excluding the amenorrhea of ​​pregnancy and That by breastfeeding (amenorrhea
physiological), every other amenorrhea is to be Considered patologic.
Moreover, we Distinguish primary amenorrhea, a when at the age of 18 years have not yet Appeared flows
menstrual, and secondary amenorrhea, a when you have amenorrhea for at least 3 months after a period of
regular menstruation.
 

2

classification

primary amenorrhea, a when at the age of 18 years have not yet Appeared flows menstrual

secondary amenorrhea, a when you have amenorrhea for at least 3 months after a period of
regular menstruation.

3

Amenorea could be because of:

• anatomical and functional abnormalities of the uterus and / or lower genital tract: amenorrhea uterine and vaginal
• Alterations anatomical and functional borne ovary: ovarian amenorrhea
• Alterations anatomical and functional adenohypophysis and / or hypothalamus: hypothalamic amenorrhea pituitary
• incoordination of the hypothalamic-pituitary-ovarian: amenorrhea alterations mechanisms feedback
• extragenital disorders: endocrine Extragenital, general diseases, metabolic disorders
 

4

Amenorrhea source uterine and vaginal. Causes.


Between changes in the uterus and lower genital tract That determinates primary amenorrhea, there are the
congenital malformations,: such as partial or complete agenesis of the vagina, uterine agenesis, cervical atresia,
cable uterine atresia

Also:

  • Rokitansky-Kuster-Hauser syndrome
  • uterine synechiae intracavitary

5

what is Rokitansky-Kuster-Hauser syndrome

Rokitansky-Kuster-Hauser syndrome 
caratterizzata by aplasia vagunale and uterine horns atretic. The
ovary, However, are normal with normal development of secondary sexual characteristics. This syndrome,
then, is associated with other malformations of the urinary tract

6

what is sinechie uterine intracavitarie?


can be traumatic and post-emergence after revisions
partum or after incomplete abortions (Asherman's syndrome) or arise from infection
endometrial (TBC, Chlamydia, sepsis IUD), or even as a result of intervention on the cervix or in
Diatermo-coagulation. The uterine synechiae That determinates complete obliteration of the cavity or
occlusion of the cervical canal, induces secondary amenorrhea, Unless they start earlier
puberty (tuberculous endometritis), causing primary amenorrhea
 

7

what is criptomenorrhea?


In the presence of obstruction of lower genital tract are talking about criptomenorrea; in cases of imperforate hymen the
menstrual blood can not drain out and collects first in the vagina (ematocolpo) and
later in the uterine cavity (ematometra) with onset of menstrual pain recurring
 

8

Amenorrhea of ovarian origin

Gonadal dysgenesis (primary Am hypergonadotropin with low estrogen level)

Polycystic ovary syndrome

Early menopause

resistant ovary syndrome

ovarian tumors

9

Gonadial dysgenesis

Gonadal dysgenesis (primary Am hypergonadotropin with low estrogen level)

  • dysgeneses in undifferentiated gonad (Turner syndrome and its variants: Lack of ovaries(streak gonads; Female phenotyps; Sexual infantilism
  • differentiated donadal dysgenesis: the damage it causes less severe That. hypoplasia ovarian follicular heritage scarsp
  • syndromes with sexual ambiguity: These include the real and ermafroditismi pseudoermafroditismi male and female.

10

syndromes with sexual ambiquity


syndromes with sexual ambiguity: These include the real and ermafroditismi pseudoermafroditismi male and female. Are ailments linked to abnormalities
Chromosomal with discordance between phenotype and genetic sex and / or gonadal you
accompanied by primary amenorrhea. Among the bad pseudoermafroditismi deserves
mention testicular feminization syndrome or syndrome Morris, caratterizzata
by female phenotype with gonads and the hormonal Typically bad
 

11

Polycystic ovary syndrome (etiopatogeneze, clinic, diagnostic)

 

  • Aetiopathogenesis unknown
  • Clinic 
  1. Mostly secondary amenorrhea
  2. Anovulatory infertility
  3. Hirsutism and acne ipeandrogenismo
  4. Metabolic syndrome
  • ultrasound Appearance: ovaries appear increased  volume, and with whitish albuginea thick

 

12

Polycystic ovary syndrome (hormonal framework)

hormonal Framework
LH increased
FSH normal or low
Reversal of the relationship FSH / LH
Hypersecretion of androgens by the theca cells and stromal ovarian
Increased estrogen, Also Of Those peripheral, produced by adipose tissue and
adrenal gland,: such as estrone: These abnormally high levels of estrogens, Altering
That feedback mechanisms regulate the Increase cyclic gonadotropin,
would be responsible dell'anovulazione with amenorrhea and infertility

13

Early menopasue (etiopatogeneze)


Aetiopathogenesis is unknown. We hypothesized That a genetic disorder results in hypoplasia
ovarian follicular patrimony reduced. Other times, However, the normal ovaries appear

morphologically and Contain a normal number of follicles That, for different Reasons
(Viral agents, radiation, autoimmune phenomena) would face rapid and premature
destruction
 

14

early menopause (clinic)


In severe cases: primary amenorrhea with hypergonadotropic ipoestrogenica
non-appearance of secondary sexual characteristics
In other cases: Develops before un'oligomenorrea with anovulatory cycles and, then,
secondary amenorrhea ipergonadotropica ipoestrogenica, with the appearance of
estrogen deficiency symptoms typical of climacteric internships
 

15

what is resistant ovary syndrome?


resistant ovary syndrome: is caratterizzata receptor ovarian insensitivity to pituitary gonadotropins, possibly two to congenital deficiency receptor, by the presence of antibodies antirecettori ovarian or chromosomal abnormalities. Manifests, in general, with amenorrhea primary in young donni with pubertal development and normal secondary sexual characteristics

16

endocrine framework in resistant ovary syndrome; biopsy


The framework endocrine shows characteristically high levels of gonadotropins and hypoestrogenism: also,
Given the resistance ovarian, administration of gonadotropins is not accompanied by
improvement of the clinical picture.
Biopsy, the number of primordial follicles is normal.
 

17

ovarian tumors 


give secondary amenorrhea iperestrogenica, sometimes alternating with menorrhagia. It can
be linked to the presence of functioning tumors of the ovary, Which produces estrogen,: such as tumors
granulosa cell and tecomi. Alternatively, it may be linked to the presence of tumors, as
the arrenoblastoma, That produces androgens: In These cases, in Additions to the menstrual disorders, It has
virilization with appearance of male sexual characteristics
 

18

hypothalamic - pituitary amenorrhea

  •  functional hypothalamic amenorrhea associated with disorders
  • amenorrhea related to organic lesions hypothalamic-pituitary
  • Pituitary adenomas prolattinosecernenti
  • iatrogenic causes
  • syndromes associated with galactorrhea
  • Sheehan syndrome
  • empty saddle(balnas) syndrome 

19

functional hypothalamic amenorrhea associated with disorders

  • psychogenic amenorrhea
  • psychogenic Anorexia
  • Pseudociesi or imaginary pregnancy
  • post-pill amenorrhea without galactorrhoea

 

20

psychogenical amenorrhea


Secondary amenorrhea Arising are, in general, in youth
women undergoing psychological pressure of various kinds (fear, stress tests, or
sports competitions, crash dieting). Are reversible, usually you, the cessation of the stimulus
stressor. Are anche related to insufficient release of hypothalamic GnRH for
central inhibition and are caratterizzata by:
Gonadotropins very low
Estrogen below normal
Anovulation
 

21

psychogenic anoreksia


there is a deficiency in the secretion of GnRH with a framework similar to the
previous
 

22

Pseudociesi or immaginary pregnancy


very rare in women and OCCURS strongly
depressed and anxious to offspring. Besides secondary amenorrhea arise of syndromes
characteristic of a real pregnancy. The throng obsessive determines, for reduction
dopaminergic activity, hypersecretion of PL and GnRH, causing Increase in LH,
while FSH remains at reduced levels. The plasma levels of estrogen and progesterone are
carried forward to Those of a secretory phase initial
 

23

post pill amenorrhea without galattorea


 post-pill amenorrhea without galactorrhoea: is two to the failure recovery mechanisms
feedback hypothalamus-pituitary-ovary
 

24

amenorrhea related to organic lesions hypothalamic-pituitary

  • congenital (Kallman sindrome)
  • acquired 

25

amenorrhea related to organic lesions hypothalamic-pituitary (congenital)


Congenital: Kallman syndrome: Seems to be two to an alteration in the neurons of the load
core sovraottico and paracentricolare GnRH secreting. It is caratterizzata by:
Anosmi
Hypogonadism
Developmental defects of the facial skeleton
 

26

amenorrhea related to organic lesions hypothalamic-pituitary (acquired)


Inflammatory disorders
Alterations traumatic
Neoplastic changes
craniopharyngioma: is associated, as well as to amenorrhea, a growth deficit
to reduced GH secretion
Pituitary adenomas prolattinosecernenti: increased At prolactin is Associated with amenorrhea as high rates of PL interfere with hypothalamic receptors for estrogen, by Altering the feedback mechanisms.
This alteration results in reduction of the concentration of gonadotropins, anovulation and amenorrhea ipoestrogenica. In Additions to, anovulation anche Appears to be linked to direct interference of the PL
ovarian responsiveness to gonadotropins.
 

27

iatrogenic causes


Iatrogenic causes: anche hyperprolactinemia can be a result of drugs
as antipsychotics (especially first generation), and ipotensivanti Antiemetics,
That diminish a decrease in the dopaminergic tone and, Therefore, in
increased At release of PL
 

28

syndromes associated with galactorrhea


• Chiari-Frammel: OCCURS after childbirth
• Syndrome Argonz Castle: Appears outside of the states gestational
• Sherman syndrome: OCCURS after administration of
Progestogens
• Forbes-Albright syndrome: is linked to the presence of pituitary tumors
 

29

Sheehan sindrome


OCCURS Generally after a profuse bleeding post
partum Resulting in hypovolemic shock, ischemia and necrosis Subsequent
anterior pituitary. It is clinically caratterizzata:
• In the first phase (linked to kidney and gonadotrophic lattotropa)
or mammary involution
or wasting Remarkable
or Non-resumption of menstrual bleeding
• In a second phase
or failure tireotropa and corticotropa Resulting signs
• Reversibility: usually fatal in some cases may be less
relevant and reversible
 

30

empty saddle sindrom


 a condition is congenital or secondary (or trauma
radiation), in cui the sella turcica is not occupied by the pituitary, but by un'estroflessione
tank sovrachiasmatica