WH EOR
2ry amenorrhea w/ previously regular menstrual cycles
3m
2ry amenorrhea w/ previously irregular menstrual cycles
6m
What level of PRL may suggest empty sella syndrome or a pituitary issue
>100
If bleed occurs after estrogen priming
Check FSH/LH—> primary ovarian failure or pituitary tumor, eating do, chronic illness
oligomenorrhea
Fewer than 9 menstrual cycles/ yr or >35 days
If positive protestin challenge
MC PCOS
What is the definition of primary amenorrhea if sexual development
No menses by age 15 w/ normal growth
Estrogen priming
Oral conjugated estrogen 0.625/d for 35d, medroxyprogesterone added days 26-35
If no bleed for estrogen priming?
Outflow tract obstruction
Secondary dysmenorrhea
Painful menstruation related to pelvic pathology Can occur any time in the menstrual cycle
PALM-COEIN
Polyps, Adenomyosis, Leiomyomas, Malignancy, Coagulation, Ovarian dysfxn, Endometriosis, Iatrogenic, Not yet classified
If no withdraw bleed with protestin challenge
Sx of hypoestrogenism or outflow tract disorder —> estrogen priming
What labs do you order in primary amenorrhea?
hCG, FSH, TSH, PRL
If uterus is absent in primary amenorrhea, what do you order?
karyotype and serum T
primary dysmenorrhea
painful menstruation that begins at puberty and has no clear cause