Amenorrhea DI WEN M.D., Ph.D.,

Professor & Chairman

Department Of Obstetrics & Gynecology

Renji Hospital Affiliated to SJTU School of Medicine

22006-11-15 七年制

Amenorrhea

Amenorrhea Amenorrhea is the absence of menstruation.

Primary

Secondary

Absence of menses by age 16 with normal secondary sexual characteristics

Absence of menses by age 14 without secondary sexual development

Absence of menses for 6 months in a previously menstruating female

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Amenorrhea

Events of PubertyThelarche (breast development)

Requires estrogen

Pubarche/adrenarche (pubic hair development)Requires androgens

MenarcheRequires:

GnRH from the hypothalamus

FSH and LH from the pituitary

Estrogen and progesterone from the ovaries

Normal outflow tract

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Amenorrhea

P1P1

P5P5

P4P4

P3P3

P2P2

Tanner‘sTanner‘s

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Amenorrhea

Classification of amenorrhea

hypothalamic amenorrhea pituitary amenorrhea ovarian amenorrhea uterine amenorrhea

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Amenorrhea

Etiology

hypothalamic amenorrheaPsychological stress5a-Reductase deficiencyAnorexia nervosa, weight loss Increased exercise levelsKallmann syndrome drug-induced amenorrhea Space-occupying lesion of CNS

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Amenorrhea

Etiology

pituitary amenorrhea

tumor

Empty sella syndrome

Sheehan syndrome

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Amenorrhea

Etiology ovarian amenorrhea

Gonadal dysgenesis

Turner syndrome: low hair line, web neck, shield chest, and widely spaced nipples) Swyer syndrome

resistant ovary syndrome

Premature ovarian failure

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Amenorrhea

Tunner staging

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Amenorrhea

Acanthosis nigrans

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Amenorrhea

Striae

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Amenorrhea

Typical features of Turner Syndrome

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Amenorrhea

Etiology

uterine amenorrhea Absence of uterus

Asherman syndrome

anatomic abnormalities of the reproductive tract

Imperforate Hymen

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Amenorrhea

Imperforate Hymen

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Amenorrhea

Mayer-Rokitansky-Kuster-Hauser Syndrome (utero-vaginal agenesis)

15% of primary amenorrhea Normal secondary

development & external female genitalia

Normal female range testosterone level

Absent uterus and upper vagina & normal ovaries

Karyotype 46-XX15-30% renal, skeletal and

middle ear anomalies

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Amenorrhea

Androgen Insensitivity

Normal breasts but no sexual hair

Normal looking female external genitalia

Absent uterus and upper vagina

Karyotype 46, XYMale range testosterone

levelTreatment :

gonadectomy after puberty + HRT

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Amenorrhea

Diagnosis

History Physical examination

Physical examination begins with vital signs, including height and weight, and with sexual maturity ratings

Laboratory evaluation

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Amenorrhea

VE- preg test

TSH ,PROLACTIN’, Prog.challenge test

withdrawal bleeding

without withdrawal bleeding

hypoestrogenic compromised outflow tract.

+ve.est,progest.challenge test

-ve.est,progest.challenge test

FSH>30-40Normal FSH

HSG OR hysteroscopy asherman

2wk

FSH norm.

repeatRepeat+serum ,est.level

PROFhypothalamic-pituitary failure

anovulation

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Amenorrhea

Treatment treatment varies depending upon the causes of

the amenorrhea. Treatment options include:Dietary changes, including an increase in fat and calories in order to stimulate estrogen production.

Counseling for eating disorders.

Using stress reduction techniques to help regulate the period.

Hormonal supplements, like the birth control pill or patch, or hormone replacement therapy.

Surgery to remove cysts, fibroids or tumors

DI WEN M.D., Ph.D.

Professor & Chairman

Department of Obstetrics & Gynecology

Renji Hospital Affiliated to SJTU School of Medicine

Thanks for Your Attention