Term
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Definition
1. No menses by age 14 in the absence of secondary sex characteristics
2. No menses by age 16 regardless of the presence of normal growth
3. In women who have had menses previously, no menses for 3 cycles or 6 months |
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Term
| Primary vs. secondary amenorrhea |
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Definition
Primary: failure of menses to begin by age 16 (UpToDate says 15)
Secondary: cessation of established menstruation |
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Term
| What should be included in the physical exam when evaluating amenorrhea? |
|
Definition
1. Ht., Wt., BMI
2. Skin, hair, nails (look for signs of hyper- or hypothyroidism; acanthosis nigricans, hirsutism)
3. Thyroid
4. Breast exam (Tanner stage, look for discharge/galactorrhea)
5. Pelvic exam |
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Term
| Lab studies for amenorrhea |
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Definition
1. Serum hCG **very important to r/o pregnancy
2. Estradiol, FSH, LH to evaluate ovaian function
3. TSH, free T4
4. Prolactin
5. Testosterone
6. Glucose |
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Term
| What are some differentials for primary amenorrhea? |
|
Definition
1. Functional hypothalamic amenorrhea (r/t diet, exercixe, low BMI, anorexia)
2. PCOS
3. Congenital GnRH deficiency
4. Hypothalamic/pituitary disease
5. Gonadal dysgenesis
6. Turner syndrome (missing X chromosome) or other chromosomal abnormalities
7. Anatomic anomalies
8. Vaginal agenesis
9. Androgen insensitivity syndrome
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|
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Term
| Differentials for secondary amenorrhea? |
|
Definition
1. Pregnancy
2. Hyperprolactinemia
3. Premature Ovarian Failure/Primary ovarian insufficiency
4. R/T hormonal contraception
5. Functional hypothalamic amenorrhea
6. Pituitary lesion
7. PCOS
8. Thyroid disease
9. Asherman's syndrome |
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Term
| How can we assess ovarian function? |
|
Definition
1. Serum estradiol
2. Progestogen challenge test (withdrawal bleed = ovarian function)
3. Measure endometrial thickness
4. Serum FSH |
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Term
| Progestogen challenge test |
|
Definition
1. Prometrium 300 mg daily for 5 days
or
2. Provera 10 mg daily for 5 days
Withdrawal bleeding should begin 7 - 10 days later provided that there is enough circulating endogenous estrogen and that the genital outflow tract is patent |
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Term
Primary ovarian insufficiency (POI)
(AKA premature ovarian failure) |
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Definition
| Cessation of ovarian function before the expected age of menopause |
|
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Term
| What percentage of women have spontaneous regression of POI and become pregnant after dx? |
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Definition
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Term
| What chromosomal abnormalities may cause POI? |
|
Definition
1. Turner syndrome
2. X chromosome mosaicism
3. Fragile X premutation
4. Trisomy X
5. Androgen insensitivity syndrome |
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Term
| Other causes of POI include: |
|
Definition
1. Galactosemia
2. Mutations of LH, FSH, inhibin or their receptors
3. Autoimmune polyendocrine syndrome
4. Chemo, radiation
5. Autoimmune oophoritis
6. Idiopathic causes |
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Term
| When should we obtain a karyotype? |
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Definition
| All women diagnosed with ovarian failure before the age of 30 should have a karyotype test |
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Term
|
Definition
1. Progestin challenge
2. Hormone replacement therapy
3. If pregnancy is desired - IVF with donor oocytes
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|
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Term
| HRT for ovarian failure/POI |
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Definition
Recomended to prevent osteoporosis
Continue until approx. 50 years of age
Androgen replacement not recommended |
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