Amenorrhea is defined as the absence of menstruation. It can be primary, occurring before age 16, or secondary, occurring after menstruation has started. Possible causes of amenorrhea include issues with the hypothalamus, pituitary gland, ovaries, or uterus. Hypothalamic amenorrhea can be caused by stress, eating disorders, excessive exercise, or certain drugs. Evaluation of amenorrhea involves assessing sexual development, hormone levels, imaging tests, and response to medication challenges to determine the underlying cause. Treatment depends on the specific cause but may include hormone replacement, surgery, or lifestyle changes.

1. Amenorrhea Zhanghuiying Department Of Obstetrics & Gynecology Tianjin Medical University General Hospital

13. Typical features of Turner’s Syndrome Sexual infantilism and short stature High FSH and LH levels. • Bilateral streaked gonads. • Karyotype - 80 % 45, X0 - 20% mosaic forms (46XX/45X0)

14. Turner’s syndrome ( Classic 45-XO) Mosaic (46-XX / 45-XO)

15. Ovarian dysgenesis streak gonad

19. Imperforate Hymen

24. Diagnosis of Amenorrhea

28. Amenorrhea with Immature Secondary Characteristics FSH Serum level Low / normal High Hypogonadotropic hypogonadism Gonadal dysgenesis

34. Negative Pregnancy.test TSH ,PROLACTIN, Progesterone challenge test withdrawal bleeding without withdrawal bleeding hypoestrogenic compromised outflow tract +ve.est/progest challenge test -ve.est/progest challenge test FSH>30-40 Normal FSH HSG OR hysteroscopy Asherman’s FSH low . repeat Repeat+serum estrogen level PreOvFailure hypothalamic-pituitary failure anovulation Procedures of Diagnosis Secondary Amenorrhea