Amenorrhea

Question 1

What is the definition of primary Amenorrhea?

Answer 1

1. No menses by the age of 15 yrs in the presence of normal secondary sexual characteristics
2. No menses within 5 years of breast development if occurs before age 10
3. No menses or development of secondary sexual characteristics by age 13

Question 2

What is the definition of secondary Amenorrhea?

Answer 2

No menses for a total of at least 3 previous cycles, 3 months

Question 3

What are the 4 main causes of Amenorrhea

Answer 3

PCOS, Hypothalamic amenorrhea, Hyperprolactinoma, ovarian failure

Question 4

Mullerian Agenesis is also known as ____.

Answer 4

Mayer-Rokitansky-Kuster-Hauser syndrome

Question 5

On physical exam what finding will indicate mullerian agenesis rather than Androgen Insensitivity?

Answer 5

Presence of pubic hair

Question 6

How do you prescribe a progesterone for a withdrawl bleed?

Answer 6

Medroxyprogesterone 10 mg PO for 5-10 days

Question 7

What does a positive withdrawl bleed indicate?

Answer 7

Functional outflow tract and presence of responsive endometrium

Question 8

Why might a progesterone whithdrawl bleed not occur in a patient with PCOS?

Answer 8

endometrium may be decidualized by high circulating androgen levels

Question 9

What does obtaining an estradiol level help achieve?

Answer 9

Whether the patient is eugonadal or hypogonadal

Question 10

What level of estrogen suggests ovarian follicular activity?

Answer 10

> 40 pg/mL

Question 11

What level of FSH suggests ovarian failure?

Answer 11

> 20 IU/L

Question 12

What level of FSH indicates hypogonadotropic hypogonadism?

Answer 12

< 5 IU/L

Question 13

Low FSH in the setting of low estradiol suggests what type of dysfunction?

Answer 13

Hypothalamic

Question 14

What labs should be obtained when evaluating a patient with amenorrhea?

Answer 14

HCG, TSH, Prolactin, FSH, Estradiol

Question 15

Hypergonadotropic Hypogonadism refers to ____

Answer 15

premature ovarian failure

Question 16

Hypogonadotropic Hypogonadism refers to_____

Answer 16

hypothalamic amenorrhea, pituitary or CNS tumor

Question 17

If both FSH and Estradiol are in the normal range are the two possible causes of amenorrhea?

Answer 17

Annovulation, Anatomic Defect

Question 18

What are the three main syndromes associated with Hypergonadotropic Hypogonadism?

Answer 18

Gonadal Dysgenesis, Primary ovarian insufficiency, Menopause

Question 19

What is the definition of primary ovarian insufficiency?

Answer 19

depletion of ovarian follicles and cessation of menses before the age of 40

Question 20

What percent of women does primary ovarian insufficiency affect?

Answer 20

1 %

Question 21

What genetic syndrome is associated with primary ovarian insufficiency?

Answer 21

Fragile X (FMR1 gene)

Question 22

What specific sex chromosomal abnormalities are associated with primary ovarian insufficiency?

Answer 22

X and Y chromosome mosaicism

Question 23

True or false: If Y chromosome present in a genetic analysis for a patient who has ammenorhea and POI, then gonads should be removed due to malignant potentia?

Answer 23

True

Question 24

In a patient with Primary ovarian Insufficiency, what Autoimmune diseases should you test for?

Answer 24

21 hydroxylase antibodies, Antithyroid antibodies

Question 25

primary ovarian insufficiency is strongly associated with what Autoimmune syndrome?

Answer 25

Adrenal Insufficiency

Question 26

Following radiation, how long does it take for menses to resume?

Answer 26

6 - 18 months

Question 27

True or false: prior radiation therapy can cause birth defects?

Answer 27

false

Question 28

Which chemotherapy agents result in highest rate of premature ovarian insufficiency?

Answer 28

Alkylating agents

Question 29

How does chemotherapy affect fertility?

Answer 29

causes depletion of primordial follicles

Question 30

What percentage of patients with premature ovarian insufficiency may conceive spontaneously?

Answer 30

5 - 10%

Question 31

What should be prescribed for patients with premature ovarian insufficiency?

Answer 31

HRT with low dose estrogen

Question 32

What must be added to HRT for those patients who still have a uterus?

Answer 32

Progesterone

Question 33

What is the most common disorder of the pituitary that causes amenorrhea?

Answer 33

Pituitary Adenoma

Question 34

What disorder of the hypothalamus is associated with Amenorrhea?

Answer 34

Kallman Syndrome

Question 35

What are common causes of hypothalamic amenorrhea?

Answer 35

Eating disorder, excessive exercise, excessive weight loss

Question 36

In a patient with hypothalamic amenorrhea, what agents must be used to achieve pregnancy?

Answer 36

Gonadotropin ovulation induction agents

Question 37

What is Kallman syndrome?

Answer 37

Congenital GnRH deficiency associated with anosmia

Question 38

What causes Kallman Syndrome?

Answer 38

failure of GnRH neurons to migrate to the hypothalamus during embryogenesis

Question 39

True or false: adrenarche is not compromised in a patient with Kallman syndrome, therefore patients will still have pubic hair

Answer 39

True