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859-III
Amenorrhea
15
Medical
Graduate
02/12/2012

Additional Medical Flashcards

 


 

Cards

Term
Amenorrhea
Definition

1. No menses by age 14 in the absence of secondary sex characteristics

2. No menses by age 16 regardless of the presence of normal growth

3. In women who have had menses previously, no menses for 3 cycles or 6 months

Term
Primary vs. secondary amenorrhea
Definition

Primary: failure of menses to begin by age 16 (UpToDate says 15)

 

Secondary: cessation of established menstruation

Term
What should be included in the physical exam when evaluating amenorrhea?
Definition

1. Ht., Wt., BMI

2. Skin, hair, nails (look for signs of hyper- or hypothyroidism; acanthosis nigricans, hirsutism)

3. Thyroid

4. Breast exam (Tanner stage, look for discharge/galactorrhea)

5. Pelvic exam

Term
Lab studies for amenorrhea
Definition

1. Serum hCG **very important to r/o pregnancy

2. Estradiol, FSH, LH to evaluate ovaian function

3. TSH, free T4

4. Prolactin

5. Testosterone

6. Glucose

Term
What are some differentials for primary amenorrhea?
Definition

1. Functional hypothalamic amenorrhea (r/t diet, exercixe, low BMI, anorexia)

2. PCOS

3. Congenital GnRH deficiency

4. Hypothalamic/pituitary disease

5. Gonadal dysgenesis

6. Turner syndrome (missing X chromosome) or other chromosomal abnormalities

7. Anatomic anomalies

8. Vaginal agenesis

9. Androgen insensitivity syndrome

 

Term
Differentials for secondary amenorrhea?
Definition

1. Pregnancy

2. Hyperprolactinemia

3. Premature Ovarian Failure/Primary ovarian insufficiency

4. R/T hormonal contraception

5. Functional hypothalamic amenorrhea

6. Pituitary lesion

7. PCOS

8. Thyroid disease

9. Asherman's syndrome

Term
How can we assess ovarian function?
Definition

1. Serum estradiol

2. Progestogen challenge test (withdrawal bleed = ovarian function)

3. Measure endometrial thickness

4. Serum FSH

Term
Progestogen challenge test
Definition

1. Prometrium 300 mg daily for 5 days

 

or

 

2. Provera 10 mg daily for 5 days

 

Withdrawal bleeding should begin 7 - 10 days later provided that there is enough circulating endogenous estrogen and that the genital outflow tract is patent

Term

Primary ovarian insufficiency (POI)

 

(AKA premature ovarian failure)

Definition
Cessation of ovarian function before the expected age of menopause
Term
What percentage of women have spontaneous regression of POI and become pregnant after dx?
Definition
5 - 10%
Term
What chromosomal abnormalities may cause POI?
Definition

1. Turner syndrome 

2. X chromosome mosaicism

3. Fragile X premutation

4. Trisomy X

5. Androgen insensitivity syndrome

Term
Other causes of POI include:
Definition

1. Galactosemia

2. Mutations of LH, FSH, inhibin or their receptors

3. Autoimmune polyendocrine syndrome

4. Chemo, radiation

5. Autoimmune oophoritis

6. Idiopathic causes

Term
When should we obtain a karyotype?
Definition
All women diagnosed with ovarian failure before the age of 30 should have a karyotype test
Term
Management of POI
Definition

1. Progestin challenge

2. Hormone replacement therapy

3. If pregnancy is desired - IVF with donor oocytes

 

Term
HRT for ovarian failure/POI
Definition

Recomended to prevent osteoporosis

 

Continue until approx. 50 years of age

 

Androgen replacement not recommended

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