Download presentation
Presentation is loading. Please wait.
Published byClifton Phillips Modified over 9 years ago
1
Amenorrhea (and Dysfunctional Uterine Bleeding)
Dr. ELHAM GHANBARI JOLFAEI OB&MD Gynecologiest
2
Amenorrhea: “absence of menses”
“Normal cycle is 28 days This occurs in 15% of cycles 98% have cycles between days Average duration 4-6 days (2-8 normal) Average blood loss per cycle = 30 ml. > 80 ml. Leads to risk for anemia
3
PRIMARY AMENORRHEA Patient has never menstruated
No period by age 14 with no secondary sexual characteristics No period by age 16 regardless of secondary sexual characteristics
4
SECONDARY AMENORRHEA Previously established cycles cease
5
ALWAYS RULE OUT PREGNANCY
Then evaluate the four parts of the system
8
REASONS FOR AMENORRHEA
Pregnancy Menopause Thyroid/Prolactin Disorders Anovulation Outflow obstruction CNS/hypothalamic dysfunction Drugs/Stress/Nutrition Chromosomal/Abnormal Sexual Differentiation
9
ALWAYS RULE OUT PREGNANCY!!!!!!!
No matter WHAT!!!
10
STEP ONE – will diagnose pregnancy, thyroid disorder, hypoprolactinemia and anovulation
LABS Beta hcg TSH Prolactin MEDS Progestin challenge {If galactorrhea, obtain MRI of pituitary/sella turcica}
11
STEP TWO – will diagnose outflow tract obstruction
Give estrogen “priming”, followed by progestin Estrogen x 21 days Add progesterone for the last 5 days
12
STEP 3- will determine if lack of estrogen is due to ovarian failure vs. altered CNS/pituitary axis
FSH (LH)
14
I. UTERUS – VAGINA – OUTFLOW TRACT
Asherman’s – secondary amenorrhea Imperforate hymen – primary amenorrhea Vaginal septum – primary amenorrhea Agenesis – primary amenorrhea Testicular feminization – primary amenorrhea
16
II. OVARY Chromosomes Normal- Chromosomes Abnormal- Menopause
Radiation/Chemo Autoimmune Disorder Infection Chromosomes Abnormal- Primary Amenorrhea Premature Menopause
18
III. ANTERIOR PITUITARY
Prolactin Secreting Tumors Sheehan’s Syndrome
19
IV. CNS / HYPOTHALAMUS Weight loss, anorexia, stress, intense exercise
Hypothyroidism – TRH/drugs which affect dopamine Anovulation Hypothalamic Suppression
20
ALWAYS, ALWAYS, ALWAYS RULE OUT PREGNANCY
21
CASE STUDY 17 year old female with primary amenorrhea. She is of normal weight and has mature secondary sexual characteristics.
22
CASE STUDY 15 year old with three months of secondary amenorrhea. She underwent normal pubertal development and had menarche at age 12 with regular cycles for three years. She is on the track team.
23
CASE STUDY 42 year old G3P3 with 5 months amenorrhea. Normal weight. Has been experiencing hot flashes.
24
CASE STUDY 28 year old G2P2 with 8 months of amenorrhea. Has been gaining weight lately, feels cold all of the time, and complains of constipation and fatigue.
25
CASE STUDY 35 year old G0 with amenorrhea for 9 months. Overweight. Slightly hirsute.
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.