Amenorrhea Flashcards
(40 cards)
Primary vs Secondary Amenorrhea
Primary: No previous menses
Secondary: absence of menses for 6 mo
Most common cause of amenorrhea
-Unrecognized Pregs (most common)
Amenorrhea from hypothalamic/pituitary suppression
-Undefined, pituitary disease/tumor
-Anorexia, excessive exerci
se (Low body fat), obesity
-Thyroid disease (Hypo or hyper)
-Hyperprolactinemia - Usually due to a pit tumor (prolactin suppresses GnRH release)
Amenorrhea due to Anovulation
1) PolyCystic Ovarian Syndrome (PCOS)
- Most common endocrine disorder in reproductive-age women
- ANDROGEN EXCESS
2) Ovarian Tumor
- Disruption E/P synthesis/balance
3) Congenital adrenal hyperplasia (Excessive androgen)
Last cause of Amenorrhea
Premature ovarian insufficiency
Treatment with Progestins. Why?
To identify cause
Diagnostic Oral or IM MPA for 10-14 d
1) If estradiol levels are sufficient, withdrawal bleeding will occur upon cessation
- -> Amenorrhea is anovulatory
2) failure to induce menses –> low estrogen levels
- -> ovarian dysfunction
- ->hypothalamic/pit dysfunction, hyperprolactinemia
3) Uterine problems
Hypothalamic (Hypoestrogenic) amenorrhea
Tx
- Treat with estrogen +/- progestins
- Will reduce the risk of oteoporosis and other signs of insufficient estrogen (hot flashes, insomnia)
Hyperprolactinemia
Dx
blood prolactin levels over 100 ng/ml –> pituitary adenoma
Hyperprolactinemia:
Other etiologies
OC, antipsychotics, antidepressants:
- Antag. dop release –> disinhibition of prolactin release
- DAR blockers
- Imipramines & SSRIs
- H2 antagonist
Hyperprolactinemia
Tx
Dopamine agonist:
Cabergoline first line
2X weekly
-dopamine will suppress prolactin release
PCOS
presentation
- Amenorrhea or menorrhagia
- Anovulatory bleeding (non-cyclical)
- -> CL does not form and progesterone not secreted
- ->increased LH
- -> Unopposed production of estradiol (Fat tissue) –>endometrium overgrowth–>necrosis and irregular bleeding
- Increased T from Theca cells
What is considered to be a disorder of androgen excess?
PolyCystic Ovarian Syndrome
What is PCOS a risk factor for?
Metabolic syndrom, T2DM, dyslipidemia, and CVD
Characteristics of PCOS
-Menstrual abnormalities
-Infertility
-Hyperandrogenism/virilization
-Obesity
Symptoms of diabetes/insulin resistance
What is the most frequent cause of anovulatory infertility and most common endocrine disease of reproductive age women?
PCOS
PCOS Risk Factors
Family History of PCOS
Central obesity
PCOS cause/Dx
Estrogen
Underlying defect unknown
- Elevated LH/FSH ratio
- Arrest of follicular development
- Adipose cells contribute to androgen aromatization to estrogen –> estrogen up–> FSH down –> Obese have increased E and T
PCOS cause/Dx
Testosterone
Elevated plasma T
- Total T normal
- free T elevated due to lower Sex Hormone Binding Globulin
-Must exclude androgen-secreting tumors
PCOS Tx goals
1) Reduce ovarian androgen secretion and restore normal hormonal cycle
- Normalize endometrium
- Restore fertility
2) Reduce insulin resistance
- Weight Loss
- Metformin
PCOS first line therapy
CHC
PCOS CHC effects
1) Restores normal hormonal cycle
2) increases SHBG to decreasae free T
3) Reduce ovarian hormone production –> decreased androgen
4) Decrease hyperandrogenemia, hirsutism,
PCOS CHC Contraindications
-Not if pregnancy is goal
-not if estrogens are contraindcated
Eg, Breast/uterine/endoM/ ovarian cancers, CVD
-Androgenic progestins avoided
PCOS CHC preferred progestin. Why
Desogestrel.
Non-androgenic
