Medical Archive

Amenorrhea without Secondary Sexual Characteristics

Causes of primary amenorrhea

1° amenorrhea	2? ?? ?? 13???, 2? ?? ?? 15???
Hyper-Hypo ?? ??	Turner SD – Ovary ?? ??? E ?? ??  Swyer SD – XY; SRY defect. ? streak gonad, ??X ??? ??O Androgen insensitivity syndrome – XY; ??O ??X ??X
Hypo-Hypo- ?? ??	Pituitary ??? ??? delay (m/c) Kallmann (2nd), CNS tumor (m/c: craniopharyngioma)

Evaluation of Women with Amenorrhea Associated with the Absence of Secondary Sexual Characteristics

Treatment of Amenorrhea Associated with the Absence of Secondary Sexual Characteristics

hMG (FSH/LH ??), pulsatile GnRH (? ??)
Cyclic E+P: 1-21?: E / 18-28?: P – ? ?? ?? ? HRT? ?? ??
Y cell line? ???? gonad removal (malig ??)

Amenorrhea with Secondary Sexual Characteristics and Abnormalities of Pelvic Anatomy

Causes

Imperforate hymen, Vaginal septum – ???? (PID ?? ??)
MRKH SD – 46,XX – ?? ?? – mullerian anomalies (??? ????? ????? ??)
AIS – 46,XY – ?? ?? – pubic hair? ??.
Asherman SD

Evaluation of Women with Amenorrhea, Normal Secondary Sexual Characteristics, and Suspected Anatomic Abnormalities

Treatment of Women with Amenorrhea, Normal Secondary Sexual Characteristics, and Abnormalities of Pelvic Anatomy

Amenorrhea with Secondary Sexual Characteristics and Normal Pelvic Anatomy

>3 months in women with previously regular menses
>6 months in women with previously irregular menses

Causes

????: Pregnancy, Hyperprolactinemia, Hyper/hypothyroidism
??? ?? ? ???? ???? ? GnRH pulse ?? ?? ? ??? ??
???? 3? ??: PCOS, CAH, Cushing

• Primary ovarian insufficiency
  • Fragile X syndrome (FMR1 gene) premutation carriers (ie, those with 50-200 CGG repeats) ? accelerated follicle depletion.
  • Turner syndrome

Evaluation for Women with Amenorrhea in the Presence of Normal Pelvic Anatomy and Normal Secondary Sexual Characteristics

• P challenge test
  • ??? ?? ??? Anovulation??
  • ??? HPO axis ??
• E challenge test
• Functional hypothalamic amenorrhea (FHA): ?adipose tissue stores ? ?circulating leptin  ? inhibits pulsatile GnRH release

Treatment for Women with Amenorrhea in the Presence of Normal Pelvic Anatomy and Normal Secondary Sexual Characteristics

• Primary ovarian insufficiency
  • Estrogen-containing therapy to reduce the risk of comorbidities associated with low estrogen levels (eg, osteoporosis, cardiovascular disease)