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21 Cards in this Set
- Front
- Back
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Primary amenorrhea
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No period by 14 with no secondary sex characteristics
No period by 16 with secondary sex characteristics |
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Secondary amenorrhea
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6 months without a period or 3 cycle equivalent
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Most common causes of amenorrhea
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Pregnancy
Functional hypothalamic amenorrhea PCOS |
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Functional hypothalamic amenorrhea
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No pulsatile GnRH release
Due to weight loss, exercise, or stress Most recover without intervention |
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Good porgnostic indicators in functional hypothalamic amenorrhea
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High BMI
High androstenedione Low cortisol |
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Female athlete triad
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Amenorrhea
Osteoporosis Eating disorder |
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Female athlete triad pathophysiology
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Decreased GnRH pulsatility leading to low LH, FSH, and estradiol
Causes hypercortisolism, hypothyroid, and energy drain More in runners and ballerinas |
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Anorexia pathophysiology
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Decreased GnRH pulsatility, low LH/FSH, high cortisol
Starvation response with osteoporosis Lack of leptin made by fat cells to help trigger GnRH |
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Hypothyroidism
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Increases TRH, which inhibits GnRH
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Prolactinoma
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Prolactin inhibits GnRH release
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Management of macroadenoma
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Screen for TSH, GH, ACTH
Can cause blurred vision and headaches Shrink with DA agonist, then use surgery (high complication rate) |
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Microadenoma
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DA to shrink
ERT for amenorrhea |
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PCOS
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Abnormal steroid production
Oligomenorrhea Ovarian cysts Acne, hirsutism, and high testosterone levels (hyperandrogenism) |
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Premature ovarian failure
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Early follicle depletion with high FSH levels
Idiopathic, autoimmune, or dose-dependent radiation or chemo |
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Ovarian cryopreservation
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Oopherectomy prior to radiation and chemo
Freeze ovary, then inject back |
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Complications of ovarian cryopreservation
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Can reinject malignant cells
Reperfusion injury |
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Turner's syndrome
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45X
<5 feet tall Ovarian failure by age 30 Webbed neck Wide spaced nipples Low set ears Low posterior hairline |
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Asherman's syndrome
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Due to overzealous D&C or uterine artery embolus
Scarring and synechiae along uterine cavity Diagnose with hysteroscopy or HSG Resect synechiae High rate of placenta accreta and severe hemorrhage after repair |
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Approach to amenorrhea
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hCG test for pregnancy
TSH and prolactin for hypothyroidism and prolactinoma Progestin challenge - bleeding on progesterone indicates low estrogen - usually PCOS Estrogen-progestin challenge - uterine defect if no bleeding Check FSH/LH - increase means ovarian failure, decrease means pituitary or hypothalamus |
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Dysfunctional uterine bleeding - causes
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PCOS
Obesity Hyperandrogen (anovulation) |
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Management of dysfunctional uterine bleeding
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Rule out anatomic causes
OCs or progestins to establish regular bleeding |
