amenorrheaDone By : Sumayyah Juaid R2

Supervesised By : Nabeel Brasha

wikipedia

an abnormal absence of menstruation.

ORIGIN from Greek

clinically

Primary Primary Secondary Secondary

Classification of amenorrhea

Hypothalamic Amenorrhea

Pituitary Amenorrhea

Ovarian Amenorrhea

Uterine Amenorrhea

Events of Puberty

Thelarche :

• the breast development

• Requires estrogenestrogen

Pubarche/adrenarche :

pubic hair development

Requires androgensandrogens

Events of Puberty

Menarche :

Requires:

GnRHGnRH from the hypothalamus

FSHFSH and LHLH from the pituitary

Estrogen and progesteroneEstrogen and progesterone from the ovaries

Normal outflow tract

Events of Puberty

functional menses

Compartment ICompartment Ioutflow tract ( uterine target organ)

Compartment IICompartment IIovary ( Estrogen & Progesterone)

Compartment IIICompartment IIIAnterior Pituitary

Compartment IVCompartment IVCNS ( Hypothalamic )

primary amenorrhea

primary amenorrhea ‣pregnancy‣anatomical defects‣...... 2nd ry amenorrhea

‣mullerian a-genesis ‣testicular feminaization

‣gonadal disorders‣CNS : hypothalamic-pituitary

‣RARE

✴pregnancy

✴anatomical defects :mullerian anaomalies : imperforated hymen, vaginal septum,

✴causes 2nd ry amenorrhea :hypothalamic, pituitary ,ovarian ,uterine etiology

(Mayer-Rokitansky-Kuster-Hauser syndrome)

46 XX

Typical features of

Turner SyndromeTurner Syndrome

hypogonadotropic hypogonadism

✴ 2nd most common

✴ insufficient pulsatile pulsatile secretion of GnRH secretion of GnRH → leads to deficiencies in FSH and LH

✴ normal height for their age

✴ most common

✴ the lack of physical development caused by delayed reactivation of the delayed reactivation of the GnRH pulse generatorGnRH pulse generator

✴short for their chronologic agenormal for their bone age

•A craniopharyngioma is a benign tumor that develops near the pituitary gland .

• most commonly in childhood and adolescence and in later adult life.compresses the pituitary stalk or gland, the tumor can cause partial or complete pituitary hormone deficiency.

17,20 -desmolase deficincy

agonadieisim

17 alf-hydroxylase deficincy (46, XY )

secondary amenorrhea Compartment ICompartment Ioutflow tract ( uterine target organ)

pregnancy

Asherman's Syndrome (synchiea)

secondary amenorrhea

• Premature Ovarian Failure

• Resistance Ovarian Syndrome(ovarian hypofolliculogenesis)

• Radiation & Chemotherapy . Radiation & Chemotherapy .

Compartment IICompartment II Ovary (Hypergonadotropic Hypogonadism)

secondary amenorrhea

•Hyper - prolactinemia

• Tumors

• Shehan Syndrome

Compartment IIICompartment IIIAnterior Pituitary

secondary amenorrhea

• Hypothyrodesim

• Stress anxiety

• Anorexia

• Excessive Exercise

• Drugs

Compartment IVCompartment IVCNS ( Hypothalamic )

Clinical assessment 1- BHCG

2- TFT

3- Prolactin

TOP

Bottom

1. Provera 10 mg PO once daily 7-10 days or

2. Norethindrone 5 mg PO once daily for 7-10 days or

3. Progesterone 200 mg IM for one dose .

Progesterone Challenge Test :

1. Premarin 1.25 mg orally daily for 21 days

2. Oral Contraceptive for 2 Cycles

3. Estradiol 2 mg orally daily for 21 days and Follow with 7-10 days of Progesterone

estrogen progesterone challenge test

step 2

step 3

thanks