Amenorrhea Flashcards
(43 cards)
primary amenorrhea
NO menses by 13 + absence of growth of secondary sex characteristics
NO menses by 15 but secondary sex characteristics present
secondary amenorrhea
previously had menses AND
absence of menses more than 3 mo in girls who had REGULAR menses
OR 6 mo in girls who had IRREGULAR menses
causes of primary amenorrhea
genetic, anatomic abnormalities
- chromosome
- absence of structure
- physiologic delay
- PCOS
- Isolated GnRH deficiency
- transverse vaginal septum/imperforate hymen
- weight loss/anorexia
- pituitary disease
MC cause of secondary amenorrhea
pregnancy
HPO axis
hypothalamus -> GnRH -> anterior pituitary -> LH/FSH -> ovaries -> progesterone and estrogen -> hypothalamus
amenorrhea work up
- Serum HCG (r/o pregnancy)
- TSH, FSH, Prolactin
- pelvic U/S
- Progestin Challenge Test
- +/- MRI
Progestin Challenge Test
why do we do it>
asses level of endogenous estrogen and competence of outflow track
give stimulant to start
Progestin Challenge Test options (3) for step 1
- parenteral progesterone oil
- oral micronized progesterone
- oral medroxyprogesterone acetate
what to we look for in step 1 of Progestin Challenge Test ? what does it mean?
Did vaginal bleeding occur in 2-7 days?
yes: bleeding = anovulation
no: hypogonadism
why do we treat anovulatory patients?
if untreated unopposed estrogen can cause endometrial hyperplasia
tx: provera at beginning of month + OCP
Progestin Challenge Test
withdrawal bleeding NOT occur - management
target organ outflow tract is not working - estrogen proliferation of endometrium has not occurred
give estrogen and progesterone (STEP 2)
following step 2: if bleeding does NOT occur possible etiology
Progestin Challenge Test
endometrium or outflow tract obstruction
RARE
causes of endometrium or outflow tract
aggressive curettage/Asherman’s
infection
genetic anomaly (Mullareian dysgenesis or agenesis)
Progestin Challenge Test bleeding occurs following step 2
issue is with body’s ability to stimulate estrogen production
continue to step 3
step 3 of Progestin Challenge Test
bioassay levels of gonadotropins
2 weeks after e/p test
draw LH and FH levels
hypergonadotrophic causes (main)
bilateral oophorectomy
post menopausal
ovarian failure
hypergonadotrophin increases GnRH
- ectopic gonadotropin
- perimenopausal period (rising FSH)
- gonadotropin secreting pituitary adenomas
- resistant or insensitive ovary syndrome
5-7. autoimmune dz, galactosemia, 17 hydroxylase
causes of hypogonadotrophic
- pre pubertal
- hypothalamic dysfunction
- pituitary dysfunction
evaluation of hypogonadotrophc
imaging of sella turcica = MRI
micro adenomas - not important
macro adenoma= refer and serious
disorder of outflow tract of uterus (list)
- asherman’s syndrome
- mullarian anomalies
- mullein agenesis
- androgen insensitivity
asherman’s syndrome
intrauterine scaring and adhesions
diagnosed by hysteroscopy
tx: lysis of adhesions
complications of asherman’s
infertility
miscarriage
dysmenorrhea
mullerian anomalies
causes
imperforate hymen
obliteration of oriface
presence or absence of uterus or cervix
mullerian anomalies
associated s/s
pelvic pain
infertility or recurrent miscarriages
