Secondary Amenorrhea

Symptoms of estrogen deficiency include:

-Hot flashes -Vaginal dryness -Poor sleep -Decreased libido

List the level of the control of the menstrual cycle:

-Hypothalamus -Pituitary -Ovary -Uterus -Cervix -Vagina

To diagnose PCOS patients must have 2 out of the 3 symptoms:

-Oligomenorrhea/amenorrhea -signs of androgen excess -presence of polycystic ovaries on ultrasound >12 follicles.

List in order the causes of secondary amenorrhea after pregnancy:

-Ovarian disease (40%) -Hypothalamic dysfunction (35%) -Pituitary disease (19%) -Uterine disease (5%) -Other (1%)

Structural etiologies of secondary amenorrhea include:

-Uterine scarring -Ashmerman's syndrome (adhesions form usually from multiple DNC's or infection) -endometrial ablation -LEEP (Loop Electrosurgical Excision Procedure-removes abnormal cells) -Conization (cone biopsy)

Causes of premature menopause include:

-autoimmune conditions -chemotherapy/radiation -Fragile X premutation -Karyotypic abnormalities -Turner syndrome -Surgical

Hypothalamic dysfunction causing secondary amenorrhea include:

-functional hypothalamic amenorrhea -Inflammatory or infiltrative diseases of the hypothalamus (lymphoma, Langerhans cell histiocytosis, sarcoidosis. -Systemic disease (Celiac)

Symptoms of hypothalamic-pituitary disease include:

-headaches -galactorrhea (milky discharge from nipple) -Visual field defects -Fatigue -Polyuria, polydipsia

Causes of pituitary dysfunction that causes secondary amenorrhea include:

-hyperprolactinemia -pituitary adenomas -other pituitary masses -pituitary infarct/infiltration

Treatment for secondary amenorrhea due to washerman's syndrome include:

-hysteroscopic lysis of adhesions -long-term estrogen administration to stimulate regrowth of endometrial tissue.

Treatment for secondary amenorrhea due to functional hypothalamic amenorrhea:

-nutritional/exercise counseling -Cognitive behavioral therapy

Causes related to ovarian dysfunction that cause secondary amenorrhea.

-ovarian failure (menopause) -Hyperandrogenism (PCOS)

Treatment for secondary amenorrhea due to hyperandrogegism/pcos

-symptom management -endometrial protection via resumption of menses via OCP

Spontaneous menopause typically occurs at age

52

Premature menopause starts in women:

<40

Causes of functional hypothalamic amenorrhea include:

=Weight loss -Frequent/vigourous exercise -Stress -Severe prolonged illness

According to most sources the absence of menses must be absent for

> 6 months.

According to certain sources the absence of menses in secondary amenorrhea must be

>3cycles

If signs of hyperandrogegism obtain a :

DHEA-S (dehydroepiandrosterone) and testosterone

HPO Axis stands for

Hypothalamus Pituitary Ovary

Medications that can increase serum prolactin consequently producing amenorrhea:

Metoclopramide and antipsychotics

Rule out pregnancy with:

a urine or serum hcg

Treatment for secondary amenorrhea due to hyperprolactinema include:

dopamine agonist therapy

Absence of menses due to suppression of HPO axis in which no anatomic or organic disease is identified:

functional hypothalamic amenorrhea

Treatment for secondary amenorrhea due to primary ovarian insufficiency include:

hormone therapy for prevention of bone loss

OTHER endocrine etiologies of amenorrhea include:

hyperthyroidism/hypothyroidism -diabetes mellitus -exogenous androgen use

If FSH is high, consider a

karyotype to rule out Turner syndrome

The most common cause of secondary amenorrhea is:

pregnancy

FSH is high in

primary ovarian failure

Primary amenorrhea is

the absence of menses by age 16

Secondary menorrhea is

the absence of menses in those who have previously had menses.