Primary Amenorrhea

Turners Syndrome

45 XO Short stature, shield chest, web neck ovaries are replaced with fibrous tissue little or no estrogen managed with hormone replacement starting in teens normal uterus and vagina pregnancy possible with donated egg (IVF)

Other

Androgen Insensitivity syndrome (46 XY, with normal phenotype of female), testes may be in labia, no internal female organs,

Physical Exam

Height and weight skin breast development Pelvic examination syndromic features may need to do an ultrasound to confirm presence or absence of ovaries, uterus, cervix

Polycystic Ovarian Syndrome

Hyperandrogenism, infrequent or absent menses, obesity, ultrasound ovaries may look like a strand of pearls

Pituitary Causes

Hyperprolactinemia Pituitary adenoma may be lactating

hypothalamic causes

Hypothalmus doesn't produce a functional amount of GnRH eating disorders, vigorous exercise, high stress, treat by changing behavior, hormone supplementation

Primary Dysmenorrhea Management

NSAIDs start with onset of menses Ibuprofen 800 mg q8hrs take with food BC pills if NSAIDs aren't tolerated (estrogen-progestin)

Ovarian Causes

Polycystic ovarian syndrome premature ovarian failure these more likely present as secondary amenorrhea

Secondary Amenorrhea

absence of menses for 6 months or 3 cycle intervals in a women previously menstruating most common cause of secondary amenorrhea is pregnancy

Congential Defects

absence of uterus, cervix, and vagina transverse vaginal septum imperforate hymen

Asherman's syndrome

acquired scarring of the endometrial lining due to prior surgery or intrauterine infection

causes for primary amenorrhea

chromosomal abnormalities absence of the uterus, cervix, vagina imperforate hymen hypothalamic causes pituitary causes ovarian causes other

Kallmann's Syndrome

congenital GnRH deficiency in combination with anosmia manage with estrogen/progestin therapy GnRH can be used to induce ovulation

Tumors of the hypothalmus

decrease GnRH output craniopharyngioma, germinoma

Premature Ovarian Failure

depletion of functional oocytes prior to 40 can be genetic, autoimmune, cancer treatment, unknown

S/S dysmenorrhea

diarrhea, nausea, vomiting, backpain

Primary amenorrhea workup

history general health status pubertal milestones (axillary hair, breast development) change in weight exercise habits medication history (anti psych meds) family history

Causes of Secondary Amenorrhea

hormonal contraceptives medicated IUD Metoclopramide (causes hyperprolactinemia) Antipsychotics (thorazine, haldol, risperdal)

Labs

if uterus and vagina are present get a pregnancy test, FSH, karyotype if FSH elevated, prolactin levels if uterus is absent karyotype and serum testosterone

Etiology

increased uterine contractions dysrhythmic uterine contractions increased uterine tone GI tract stimulation

Obstruction outflow

may result in cyclic pelvic pain and can sometimes result in the formation of a mass

Primary amenorrhea

no menstral period by age 15

Secondary Dysmenorrhea

pelvic pain that occurs due to some type of pathology

Primary Dysmenorrhea

pelvic pain that occurs during mentruation in the absence of pelvic pathology Occurs with the onset of ovulatory cycles (1-3 yrs post menarche)

Indications for a pelvic

severe signs and symptoms sexually active transabdominal ultrasound can be helpful in the stead of pelvic