Amenorrhea

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Amenorrhea
DI WEN M.D., Ph.D.,
Professor Chairman
Department Of
Obstetrics Gynecology
Renji Hospital Affiliated to SJTU
School of Medicine
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Amenorrhea

• Amenorrhea is the absence of menstruation.
• Primary
• Absence of menses by age 16 with normal secondary
  sexual characteristics.
• Absence of menses by age 14 without secondary
  sexual development.
• Secondary
• Absence of menses for 6 months in a previously
  menstruating female.

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Events of Puberty

• Thelarche (breast development)
• Requires estrogen
• Pubarche/adrenarche (pubic hair development)
• Requires androgens

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Events of Puberty

• Menarche
• Requires
• GnRH from the hypothalamus
• FSH and LH from the pituitary
• Estrogen and progesterone from the ovaries
• Normal outflow tract

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Classification of amenorrhea

• hypothalamic amenorrhea
• pituitary amenorrhea
• ovarian amenorrhea
• uterine amenorrhea

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Etiology

• hypothalamic amenorrhea
• Psychological stress
• 5a-Reductase deficiency
• Anorexia nervosa, weight loss
• Increased exercise levels
• Kallmann syndrome
• drug-induced amenorrhea
• Space-occupying lesion of CNS

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Etiology

• pituitary amenorrhea
• tumor
• Empty sella syndrome
• Sheehan syndrome

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Etiology

• ovarian amenorrhea
• Gonadal dysgenesis
• Turner syndrome low hair line, web neck, shield
  chest, and widely spaced nipples
• Swyer syndrome
• resistant ovary syndrome
• Premature ovarian failure

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Tunner staging
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Acanthosis nigrans
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Striae
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Typical features of Turner Syndrome
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Etiology

• uterine amenorrhea
• Absence of uterus
• Asherman syndrome
• anatomic abnormalities of the reproductive tract
• Imperforate Hymen

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Imperforate Hymen
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Mayer-Rokitansky-Kuster-Hauser Syndrome
(utero-vaginal agenesis)

• 15 of primary amenorrhea
• Normal secondary development external female
  genitalia
• Normal female range testosterone level
• Absent uterus and upper vagina normal ovaries
• Karyotype 46-XX
• 1530 renal, skeletal and middle ear anomalies

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Androgen Insensitivity

• Normal breasts but no sexual hair
• Normal looking female external genitalia
• Absent uterus and upper vagina
• Karyotype 46, XY
• Male range testosterone level
• Treatment gonadectomy after puberty HRT

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Diagnosis

• History
• Physical examination
• Physical examination begins with vital signs,
  including height and weight, and with sexual
  maturity ratings
• Laboratory evaluation

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VE- preg test
TSH ,PROLACTIN, Prog.challenge test
without withdrawal bleeding
withdrawal bleeding
compromised outflow tract.
hypoestrogenic
anovulation
ve.est,progest.challenge test
-ve.est,progest .challenge test
2wk
Normal FSH
FSH norm.
FSHgt30-40
Repeatserum ,est.level
repeat
HSG OR hysteroscopy asherman
hypothalamic-pituitary failure
PROF
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Treatment

• treatment varies depending upon the causes of
  the amenorrhea. Treatment options include
• Dietary changes, including an increase in fat and
  calories in order to stimulate estrogen
  production.
• Counseling for eating disorders.
• Using stress reduction techniques to help
  regulate the period.
• Hormonal supplements, like the birth control pill
  or patch, or hormone replacement therapy.
• Surgery to remove cysts, fibroids or tumors

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Thanks for Your Attention
DI WEN M.D., Ph.D.
Professor Chairman
Department of
Obstetrics Gynecology
Renji Hospital Affiliated to SJTU
School of Medicine