SECONDARY AMENORRHOEA.

Question 1

What is the definition of amenorrhea in girls or women who had irregular menses?

Answer 1

Absence of menses for more than 6 months.

Question 2

What is the definition of amenorrhea in girls or women who had regular menses?

Answer 2

More than 3 months in girls/women who previously had regular menstrual cycles

Question 3

What is the most common cause of secondary amenorrhea?

Answer 3

Pregnancy

Question 4

What is the first step in evaluating any woman with amenorrhea?

Answer 4

Pregnancy test

Question 5

What is functional hypothalamic amenorrhea characterized by?

Answer 5

Functional hypothalamic amenorrhea is characterized by a presumed decrease in hypothalamic GnRH, excluding diseases.

Question 6

What is the effect of hyperprolactinemia on hypothalamic GnRH secretion?

Answer 6

Hyperprolactinemia causes amenorrhea by suppressing hypothalamic GnRH secretion.

Question 7

What is the only uterine cause of secondary amenorrhea mentioned in the text?

Answer 7

Intrauterine adhesions (Asherman syndrome) is the only uterine cause of secondary amenorrhea.

Question 8

What are the minimal criteria for the diagnosis of Polycystic ovary syndrome (PCOS)?

Answer 8

two out of three of the following:
●(1) hyperandrogenism,
●(2) oligomenorrhea or amenorrhea, and
●(3) polycystic ovaries on ultrasound

Question 9

What may cause primary ovarian insufficiency (POI)?

Answer 9

Complete or partial loss of an X chromosome (Turner syndrome),
●Fragile X premutation, (excess number of repeats in a gene)
●Autoimmune ovarian destruction,
●Radiation therapy or chemotherapy (cyclophosphamide)

Question 10

What can cause a reversibly enlarged pituitary gland?

Answer 10

hypothyroidism is a potential cause of a reversibly enlarged pituitary gland, due to thyrotroph hyperplasia, lactotroph hyperplasia, or both.

Question 11

What syndrome results from acquired scarring of the endometrial lining?

Answer 11

Asherman syndrome. It’s a condition where acquired scarring of the endometrial lining leads to abnormal menstrual bleeding or amenorrhea.

Question 12

What is Sheehan syndrome related to in the context of amenorrhea?

Answer 12

Sheehan syndrome is related to pituitary disease, specifically necrosis of the pituitary gland, often due to postpartum hemorrhage or other ischemic events, leading to decreased hormone production, including FSH and LH, which can cause amenorrhea.

Question 13

What type of tumors may present with secondary amenorrhea due to inhibin secretion?

Answer 13

Ovarian tumors, specifically those secreting inhibin, may present with secondary amenorrhea.

Question 14

What are some risk factors for functional hypothalamic amenorrhea?

Answer 14

Functional hypothalamic amenorrhea can be triggered by factors such as:

1. Extreme weight loss
2. Anorexia nervosa
3. Severe illness
4. Excessive exercise

These factors can disrupt GnRH secretion, leading to amenorrhea.

Question 15

What lab finding is characteristic of polycystic ovary syndrome (PCOS)?

Answer 15

The “string of beads” appearance on ultrasound is characteristic of polycystic ovary syndrome (PCOS). This refers to the presence of multiple small cysts around the periphery of the ovaries.

Question 16

Cervical causes of secondary amenorrhea

Answer 16

Cervical stenosis
●Usually associated with cyclical pelvic pain