1. Menstruation Is the endpoint of a cascade of events which begins in the hypothalamus and ends at the uterus

3. AMENORRHOEA

4. DEFINITION Complete absence of menstrual bleeding.

5. A. Cryptomenorrhoea (False) B. True Amenorrhoea Physiological Pathological Primary Secondary CLASSIFICATION

6. Primary: No spontaneous onset of menstruation by the age of 16 years. Secondary:Absence of menstruation for 6 months or longer if the patient has previously experienced regular menses.

7. CRYPTOMENORRHOEA Regular shedding of endometrium,but there is mechanical obstruction.

8. CAUSES Vagina 1 Imperforate Hymen 2 Non canalisation or absence of vagina Cervix 1.Congenital 2.Acquired Infection Trauma Surgery

9. CRYPTOMENORRHOEA Signs 1.Amenorrhea 2.Pain 3.Retention of urine Signs 1.Secondary sexual characters are present 2.Dark bluish membrane (imperforate hymen) 3.Pelvic mass

10. Treatment 1.Hymenectomy 2.Vaginoplasty 3.Cervical dilatation.

11. Physiological Amenorrhea Prepuberty: – Due to low production of gonadotrophic hormones Pregnancy: – Increased amounts of oestrogens & progesterone by placenta Lactation: Increased levels of prolactin Menopause: ovaries unresponsive to stimulus of gonadotrophins Constitutional delay: Familial

12. PATHOLOGICAL Causes: Uterus Ovary Anterior pituitary Hypothalamus Others

13. Causes of Amenorrhea Uterus Absence of Uterus I.Congenital II.Surgical Diseases of Endometrium I.T.B II.Destruction of Endometrium Irradiation Asherman’s Syndrome

14. Causes of Amenorrhea Ovaries Absent or Streak Ovaries Chromosomal Anomalies I.Turner (XO) II.Trisomy (XXX) III.Gonadal Dysgenesis IV.Androgen insensitivity Syndrome Bilateral Oophorectomy Irradiation Abnormal production of Hormone – PCOD

15. Causes of Amenorrhea Neoplasms – Hormone Producing Tumours – Oestrogen Producing I.Granulosa Cell II.Theca Cell Androgens Producing Tumours I.Arrhenoblastoma

16. Anterior Pituitary Congenital Defect Empty Sella Syndrome Ischemia Damage Sheehan Syndrome Neoplasms Craniopharyngioma Hypophysectomy

17. Hypothalamus Psychological Excitement, Depression, Anxiety Change of environment, climate, job Anorexia nervosa Pseudocyesis

18. Hypothalamus Neurological Inflammatory Traumatic – Fracture of skull Neoplasms Drugs

19. Other Causes Endocrinal Diseases Thyroid gland Adrenal cortex Diabetes Mellitus Acute or Chronic Illness T.B Malignant diseases Renal failure

20. Other Causes Changes In Weight Exogenous Hormones Excessive exercise

21. MANAGEMENT History of the patient. General physical examination. Pelvic Examination. Investigations.

22. INVESTIGATIONS Blood Complete picture,BGR. Urine Analysis Ultrasonography Radiological X-ray of the skull and Chest Intravenous Urography CT scan/MRI

23. Hormone Assay FSH LH Prolactin Testosterone SHBG Thyroid Tests

24. Endometrial Biopsy Buccal Smear Karyotyping Laparoscopy,Hysteroscopy Therapeutic Test

27. TREATMENT General Measures. Reassurance and psychotherapy. Nutrition. Weight Control.

28. END OF LESSON