Amenorrhea

Question 1

Define amenorrhea.

Answer 1

absence of menses

Question 2

Mention types of amenorrhea. (2)

Answer 2

1. Primary
2. Secondary

Question 3

Explain primary amenorrhea.

Answer 3

a) no menses after 16 yrs of age with secondary sexual characteristics= DELAYES PUBERTY
b) no menses after 14 yrs of age without secondary sexual characteristics

Question 4

Explain secondary amenorrhea.

Answer 4

a) absence of menses for >3 months with previous normal menstruation
b) absence of menses for >6 months with previous oligomenorrhea

Question 5

Mention causes of primary amenorrhea acc to anatomical structure. (4)

Answer 5

1. Ovarian
2. Uterine
3. Pituitary
4. Hypothalamic

Question 6

What will happen to FSH and Estrogen levels in 4 causes of primary amenorrhea?

Answer 6

1. Ovarian= increases FSH, decreased Estrogen
2. Uterine= Normal
3. Pituitary= both decreased
4. Hypothalamic= both decreased

Question 7

Name ovarian causes of primary amenorrhea. (4)

Answer 7

1. Gonadal dysgenesis
2. PCOD
3. Premature ovarian follicle
4. Savage syndrome

Question 8

What is gonadal dysgenesis?

Answer 8

Atypical development of gonads -Turner’s syndrome

Question 9

(In short) PCOD causes (2 main), which hormones increase (2), main 3 c/f.

Answer 9

CAUSES= genetic, lifestyle
HORMONES= androgens, insulin
C/F= anovulation, hirsutism, acne

Question 10

What is premature ovarian follicle?

Answer 10

loss of ovarian function before 40 yrs age

Question 11

What is savage syndrome?

Answer 11

ovarian resistance d/t FSH receptor dysfunction

Question 12

What are uterine causes of primary amenorrhea? (4)

Answer 12

1. Mullerian agenesis
2. Imperforate hymen
3. Transvaginal septum
4. Cervical stenosis

Question 13

What is mullerian agenesis?

Answer 13

absence of uterus & vagina (MRKH syndrome)

Question 14

What are pituitary causes of primary amenorrhea? (4)

Answer 14

1. Neoplasms= prolactinomas
2. Hyperprolactinemia
3. Empty sella turcica (pituitary gland shrinks)
4. Pituitarism

Question 15

What are hypothalamic causes of primary amenorrhea? (5)

Answer 15

1. Kallmann syndrome (decreased/absent GnRH)
2. Vigorous exercise, stress, weight loss, anorexia nervosa
3. Functional hypothalamic GnRH secretion decreased pulsatile GnRH secretions= anovulation
4. Hyperprolactinemia {inhibit GnRH}
5. Delayed puberty= delayed adrenarche & gonadarche

Question 16

What Dx used for primary amenorrhea?

Answer 16

1. History
2. If secondary sexual characteristics present or absent?
3. FSH & LH levels
4. USG of uterus
5. MRI

Question 17

What will be your next step if secondary sexual characters are absent or present?

Answer 17

Absent= measure FSH and LH
Present= USG uterus

Question 18

What does high levels of FSH and LH tells you?

Answer 18

-high levels= hypergonadotropic
-hypogonadism= Turner’s syndrome, Savage syndrome

Question 19

What pathologies if uterus is absent? What will be Tx?

Answer 19

Absent= Mullerian agenesis
Tx= Vaginoplasty

Question 20

What will you do next if uterus is present?

Answer 20

check for obstruction

Question 21

What pathologies if obstruction absent or present? What Tx if obstruction present?

Answer 21

Absent= secondary amenorrhea
Present= Imperforate hymen, Transverse vaginal septum
Tx= Surgery

Question 22

What is the treatment of primary amenorrhea? (2)

Answer 22

1. GnRH
2. OCPs= induce menstruation

Question 23

What are the causes of secondary amenorrhea based on anatomy? (4)

Answer 23

1. ovarian
2. uterine
3. pituitary
4. hypothalamic

Question 24

What are the ovarian causes of secondary amenorrhea? (6)

Answer 24

1. premature ovarian failure
2. premature menopause
3. pregnancy
4. PCOD
5. surgical removal of ovaries
6. masculising ovarian tumors

Question 25

What are the uterine causes of secondary amenorrhea? (5)

Answer 25

{acquired scarring of endometrium} 1. infections 2. TB 3. instrumentation (asherman's syndrome) {obstruction of cervical canal} 4. chemical burns 5. CIN

Question 26

What are the pituitary causes of secondary amenorrhea? (4)

Answer 26

1. Hyperprolactinemia 2. Sheehan syndrome 3. Pituitary tumors 4. empty sella turcica

Question 27

What are the hypothalamic causes of secondary amenorrhea? (4)

Answer 27

1. GnRH deficiency 2. Brain tumors 3. Pituitary stalk compression 4. Functional= eating disorders, weight loss, stress

Question 28

Dx of secondary amenorrhea? (6)

Answer 28

1. pregnancy test 2. FSH levels 3. Progesterone challenge test 4. Symptoms of estrogen deficiency= hot flushes, dyspareunia, dryness of vagina, loss of breast mass 5. Serum prolactin levels 6. MRI= to check tumors

Question 29

What to do next if FSH normals are low?

Answer 29

1. GnRH test unresponsive= pituitary causes 2. GnRH test responsive= hypothalamic causes 3. Measure TSH, T3, T4= to exclude panhypopituitarism

Question 30

What pathology if FSH N/increased?

Answer 30

N= PCOD Increased= Premature ovarian failure

Question 31

What if progesterone challenge test is positive or negative?

Answer 31

+ve= PCOD -ve= Hypothalamic causes

Question 32

Tx of secondary amenorrhea. (4)

Answer 32

1. Estrogen replacement therapy 2. Bromocriptine 3. Surgery 4. HRT