1) Amenorrhoea refers to the absence of menstruation and is classified as primary or secondary. Common causes include CNS issues like stress, exercise or eating disorders; pituitary disorders like Sheehan's syndrome or prolactinomas; and ovarian diseases such as PCOS or premature ovarian failure.
2) Evaluation involves assessing menstrual history, examining for signs of hormonal imbalance, and testing serum hormones and imaging studies.
3) Treatment depends on the underlying cause but may include estrogen replacement, medication to reduce prolactin levels, weight management, or lifestyle changes.
Amenorrhea is the absence of menstruation and can be primary or secondary. Primary amenorrhea refers to the absence of menstruation by age 15 in the presence of secondary sexual characteristics or by age 13 without characteristics. Secondary amenorrhea is the absence of menses for longer than 6 months in a previously menstruating woman. Common causes include pregnancy, polycystic ovarian syndrome, thyroid issues, and prolactinomas. An evaluation involves assessing sexual development, examining the reproductive tract, and obtaining levels of FSH, TSH, and prolactin to help determine the cause. Further tests like an MRI or karyotype may then be needed.
This document discusses amenorrhea, which is the absence or abnormal cessation of menstruation. It can be physiological, such as before puberty or during pregnancy and menopause, or pathological. The control of the menstrual cycle involves the hypothalamus, pituitary gland, ovaries, and outflow tract. Amenorrhea is classified as primary if a woman has not started menstruating, or secondary if established menstruation has ceased. Causes can include problems of the hypothalamus, pituitary gland, ovaries, outflow tract, or endocrine issues. Evaluation involves taking a thorough history, examination, and targeted investigations depending on suspected etiology.
A thorough history and physical examination as well as laboratory testing can help narrow the differential diagnosis of amenorrhea. In patients with primary amenorrhea, the presence or absence of sexual development should direct the evaluation. Constitutional delay of growth and puberty commonly causes primary amenorrhea in patients with no sexual development. If the patient has normal pubertal development and a uterus, the most common etiology is congenital outflow tract obstruction with a transverse vaginal septum or imperforate hymen. If laboratory tests are normal, challenge tests can help determine if the cause is an outflow tract abnormality or inadequate estrogenization. The treatment of primary and secondary amenorrhea is based on the causative factor and aims to
Secondary amenorrhea is the absence of menstrual periods for 6 months in a woman who had previously been regular, or for 12 months in a woman who had irregular periods without any physiological reasons. The most common cause is pregnancy, which should be excluded first. Once pregnancy is ruled out, further workup includes a progesterone challenge test, tests of thyroid and pituitary function like TSH, FSH, LH, and prolactin levels. These help localize the site of abnormality in the hypothalamic-pituitary-ovarian axis and identify underlying causes like PCOS, thyroid disorders, pituitary tumors, and premature ovarian failure.
CLINICAL DIAGNOSIS AND MANAGEMENT OF AMENORRHOEA BY DR SHASHWAT JANIDR SHASHWAT JANI
This clinical document provides guidelines for evaluating and managing amenorrhea. It defines primary and secondary amenorrhea and outlines the pathophysiology. The evaluation involves assessing the patient's history, physical exam, ultrasound and hormonal levels. Common causes include polycystic ovary syndrome, premature ovarian failure, hypothalamic issues, weight-related causes, and structural issues. Management aims to restore ovulation if possible or provide hormone replacement therapy to prevent health issues from estrogen deficiency.
The document discusses amenorrhea and hirsutism. It defines amenorrhea as the absence of menstruation and describes primary and secondary causes. The etiology is categorized into compartments involving the ovaries, pituitary gland, hypothalamus and outflow tract. Common conditions discussed include PCOS, Turner syndrome and premature ovarian failure. Diagnostic evaluation and treatment principles are also outlined. Hirsutism is defined as excessive terminal hair in abnormal female patterns. Common causes discussed include PCOS, CAH, tumors and idiopathic factors.
This document provides information on amenorrhea, including its classification and causes. It discusses the hypothalamic-pituitary-ovarian axis and the various etiologies of primary and secondary amenorrhea at each level of the axis. Common causes of primary amenorrhea include müllerian agenesis, androgen insensitivity syndrome, and Turner's syndrome. The most common cause of secondary amenorrhea is pregnancy, while other causes include polycystic ovarian syndrome, thyroid disorders, weight loss, and pituitary tumors. Evaluation involves history, exam, hormone levels, imaging, and challenge tests. Treatment depends on the underlying etiology and addressing irregular periods, fertility, or contraception needs.
Amenorrhea is the absence of menstruation and can be primary or secondary. Primary amenorrhea refers to the absence of menstruation by age 15 in the presence of secondary sexual characteristics or by age 13 without characteristics. Secondary amenorrhea is the absence of menses for longer than 6 months in a previously menstruating woman. Common causes include pregnancy, polycystic ovarian syndrome, thyroid issues, and prolactinomas. An evaluation involves assessing sexual development, examining the reproductive tract, and obtaining levels of FSH, TSH, and prolactin to help determine the cause. Further tests like an MRI or karyotype may then be needed.
This document discusses amenorrhea, which is the absence or abnormal cessation of menstruation. It can be physiological, such as before puberty or during pregnancy and menopause, or pathological. The control of the menstrual cycle involves the hypothalamus, pituitary gland, ovaries, and outflow tract. Amenorrhea is classified as primary if a woman has not started menstruating, or secondary if established menstruation has ceased. Causes can include problems of the hypothalamus, pituitary gland, ovaries, outflow tract, or endocrine issues. Evaluation involves taking a thorough history, examination, and targeted investigations depending on suspected etiology.
A thorough history and physical examination as well as laboratory testing can help narrow the differential diagnosis of amenorrhea. In patients with primary amenorrhea, the presence or absence of sexual development should direct the evaluation. Constitutional delay of growth and puberty commonly causes primary amenorrhea in patients with no sexual development. If the patient has normal pubertal development and a uterus, the most common etiology is congenital outflow tract obstruction with a transverse vaginal septum or imperforate hymen. If laboratory tests are normal, challenge tests can help determine if the cause is an outflow tract abnormality or inadequate estrogenization. The treatment of primary and secondary amenorrhea is based on the causative factor and aims to
Secondary amenorrhea is the absence of menstrual periods for 6 months in a woman who had previously been regular, or for 12 months in a woman who had irregular periods without any physiological reasons. The most common cause is pregnancy, which should be excluded first. Once pregnancy is ruled out, further workup includes a progesterone challenge test, tests of thyroid and pituitary function like TSH, FSH, LH, and prolactin levels. These help localize the site of abnormality in the hypothalamic-pituitary-ovarian axis and identify underlying causes like PCOS, thyroid disorders, pituitary tumors, and premature ovarian failure.
CLINICAL DIAGNOSIS AND MANAGEMENT OF AMENORRHOEA BY DR SHASHWAT JANIDR SHASHWAT JANI
This clinical document provides guidelines for evaluating and managing amenorrhea. It defines primary and secondary amenorrhea and outlines the pathophysiology. The evaluation involves assessing the patient's history, physical exam, ultrasound and hormonal levels. Common causes include polycystic ovary syndrome, premature ovarian failure, hypothalamic issues, weight-related causes, and structural issues. Management aims to restore ovulation if possible or provide hormone replacement therapy to prevent health issues from estrogen deficiency.
The document discusses amenorrhea and hirsutism. It defines amenorrhea as the absence of menstruation and describes primary and secondary causes. The etiology is categorized into compartments involving the ovaries, pituitary gland, hypothalamus and outflow tract. Common conditions discussed include PCOS, Turner syndrome and premature ovarian failure. Diagnostic evaluation and treatment principles are also outlined. Hirsutism is defined as excessive terminal hair in abnormal female patterns. Common causes discussed include PCOS, CAH, tumors and idiopathic factors.
This document provides information on amenorrhea, including its classification and causes. It discusses the hypothalamic-pituitary-ovarian axis and the various etiologies of primary and secondary amenorrhea at each level of the axis. Common causes of primary amenorrhea include müllerian agenesis, androgen insensitivity syndrome, and Turner's syndrome. The most common cause of secondary amenorrhea is pregnancy, while other causes include polycystic ovarian syndrome, thyroid disorders, weight loss, and pituitary tumors. Evaluation involves history, exam, hormone levels, imaging, and challenge tests. Treatment depends on the underlying etiology and addressing irregular periods, fertility, or contraception needs.
This document discusses guidelines for evaluating amenorrhea in adolescents and women. It recommends initiating an evaluation by age 15-16 if normal development is present, age 13 if secondary sexual characteristics are absent, or within 2 years of breast development if menarche has not occurred. Amenorrhea is classified as primary if periods never started or secondary if absent for 3-6 months. Causes can include abnormalities of the reproductive tract, hypothalamic-pituitary issues, or ovarian problems. Treatment depends on the underlying cause and may involve hormone replacement, surgery, or assisted reproduction.
Secondary amenorrhea is the absence of menses for more than three cycles or six months in women who previously had menses. Pregnancy is the most common cause. The document outlines the step-by-step process for evaluating secondary amenorrhea, including ruling out pregnancy, assessing medical history, performing a physical exam, basic lab tests, and follow-up testing and evaluation if initial results require further investigation. Treatment options are provided for common causes like hyperprolactinemia, ovarian failure, hyperandrogenism, and Asherman's syndrome.
Amenorrhea is the abnormal absence of menstruation. It is classified as primary or secondary. Primary amenorrhea occurs when menstruation does not start by age 15-16. Secondary amenorrhea is when established menstruation stops for 3-6 months. Causes can include issues with the hypothalamus, pituitary gland, ovaries, or uterus. Diagnosis involves blood tests and imaging to determine the underlying cause. Treatment depends on the specific cause but may include hormone therapy.
1. Amenorrhea is classified as primary or secondary. Secondary amenorrhea is the cessation of menses for 6 months or more in a woman who previously had menstruation.
2. Causes of secondary amenorrhea include hypogonadotropic (decreased FSH and LH), hypergonadotropic (increased FSH and LH), and eugonadotropic (normal FSH and LH) types. Specific causes include hypothalamic or pituitary disorders, polycystic ovary syndrome, premature ovarian failure, and anatomical defects.
3. Prolonged hypogonadism from secondary amenorrhea can lead to decreased bone mineral density
This document discusses amenorrhea, which is the absence of menstruation. It describes physiological amenorrhea that occurs before puberty, during pregnancy and breastfeeding, and after menopause. It also describes pathological amenorrhea, including primary amenorrhea which is the absence of menstruation without previously established cycles, and secondary amenorrhea which is the absence of menstruation for 3-6 months in women with previous regular cycles. It provides classifications and potential causes of primary and secondary amenorrhea, as well as evaluations and treatments.
This document discusses different types of amenorrhea, or absent menstrual periods. It describes primary amenorrhea, which is the absence of menstruation by age 16 with no development of secondary sex characteristics. This can be caused by hypogonadotropic or hypergonadotropic hypogonadism. Hypergonadotropic amenorrhea is often due to genetic conditions like Turner's syndrome or enzyme deficiencies. Hypogonadotropic amenorrhea has causes like Kallmann's syndrome, infections, or pituitary tumors. Treatment depends on the underlying cause and may include hormone replacement, surgery, or removal of obstructions. Anorexia nervosa can also cause amenorrhea due to severe weight loss and altered
The document discusses abnormal menstruation and amenorrhea. It defines different types of amenorrhea and outlines the basic principles of menstrual function involving 4 compartments - the central nervous system, anterior pituitary, ovary, and uterus. Common causes of amenorrhea are then reviewed for each compartment, including disorders of the ovaries, pituitary, hypothalamus, and uterus. The diagnosis and treatment of different types of amenorrhea are also summarized.
Guidelines For Management Of Adolescent PCOSMohammad Emam
The document provides guidelines for managing adolescent polycystic ovarian syndrome (PCOS), outlining a framework that includes identifying at-risk children, accurately diagnosing adolescent PCOS based on updated criteria from ESHRE 2018, and managing symptoms while preventing long-term consequences through lifestyle modifications and screening for issues like cardiovascular risk, diabetes, depression, and sleep apnea.
Menstrual dysfunction can occur due to issues with the hypothalamus, pituitary, ovary, or outflow tract. Amenorrhea is the absence of menstruation and can be primary, secondary, physiological, or pathological. Specific causes of amenorrhea include issues with the hypothalamus, pituitary, ovaries, or uterus. Polycystic ovarian syndrome is a common cause of amenorrhea and irregular periods characterized by cysts on the ovaries and increased male hormones.
This clinical guideline outlines an approach for evaluating and managing amenorrhea. Amenorrhea is classified as primary or secondary. The workup involves excluding pregnancy, cryptomenorrhea, and obtaining a history, physical exam, and ultrasound. Patients are categorized based on secondary sex characteristics, androgen levels, and test results to identify endocrine abnormalities. Management aims to restore ovulation if possible or provide hormone replacement therapy to prevent health issues. Frequent reevaluation is important given the various potential causes.
This document provides an overview of amenorrhea, beginning with definitions and classifications of primary and secondary amenorrhea. It then discusses the pathophysiology of the hypothalamic-pituitary-ovarian axis and menstrual cycle. The main causes of amenorrhea are outlined, including physiological causes as well as disorders of the hypothalamus, pituitary, thyroid, adrenals, ovaries, and uterus. The document describes the clinical evaluation of amenorrheic patients, including taking a thorough medical history and conducting a physical exam and laboratory investigations. Finally, medical and surgical treatment options are presented depending on the underlying cause of the amenorrhea.
The document provides clinical guidelines for evaluating and managing amenorrhea. It discusses the different types of amenorrhea including primary and secondary. For evaluation, it recommends taking a medical history, physical exam, ultrasound exam, and lab tests to identify potential causes. Common causes discussed include polycystic ovary syndrome, thyroid issues, eating disorders, excessive exercise, and genetic conditions. Treatment depends on the underlying cause but may include hormone replacement therapy or lifestyle changes.
Primary amenorrhea refers to the absence of menstruation. It can be caused by physiological or pathological factors. A thorough evaluation includes obtaining a medical history, physical exam, and diagnostic tests. The history aims to understand pubertal development and identify potential causes like genetic conditions, while the exam evaluates secondary sexual characteristics and external genitalia. Key tests involve hormonal profiles to classify amenorrhea as eugonadotropic, hypergonadotropic, or hypogonadotropic. Further tests like ultrasound, MRI and karyotyping help diagnose conditions like Müllerian agenesis or Turner syndrome. The goal is to understand the underlying pathology and provide appropriate treatment.
This clinical guideline outlines an approach for evaluating and managing amenorrhea. It defines primary and secondary amenorrhea and discusses various pathophysiologies including anovulatory and ovulatory causes. The approach involves obtaining a thorough history, physical exam, and initial tests to rule out pregnancy and cryptomenorrhea. Based on exam and test results, patients are categorized to guide further workup and diagnosis of conditions like hypothalamic-pituitary dysfunction, PCOS, ovarian failure, mullerian agenesis, and congenital adrenal hyperplasia. Management aims to restore ovulation if possible or provide hormone replacement therapy to prevent health issues from estrogen deficiency. Frequent re-evaluation is often needed given the complexity of
This document discusses amenorrhea, including definitions, pathophysiology, diagnostic approach, and management. Primary amenorrhea is defined as the absence of menarche by age 16 with pubertal development or by age 14 without pubertal development. Secondary amenorrhea is the absence of menstruation for 3 or more months in a previously menstruating woman. The diagnostic approach involves obtaining a thorough history, physical exam, and ultrasound to rule out pregnancy and cryptomenorrhea before classifying the patient based on endocrine abnormalities. Management aims to restore ovulatory cycles if possible or replace estrogen when deficient, with periodic progestogen to protect the endometrium.
The document discusses amenorrhea, which is the absence or abnormal cessation of menstruation. It defines physiological and pathological amenorrhea and describes the classification and etiology of primary and secondary amenorrhea. Primary amenorrhea refers to the absence of menstruation by age 16, while secondary amenorrhea is the cessation of established menses for over 6 months. Common causes include hypothalamic-pituitary-ovarian dysfunction, congenital abnormalities, pregnancy, and thyroid or weight issues.
amenorrhea is a condition when female do not have regular mensural cycles by puberty or due to any causes this ppt can help the patient and nurses to gain knowledge about this disease process and apply their knowledge into their clinical practices
The document discusses amenorrhea, which is the absence or abnormal cessation of menstruation. It can be physiological, such as during pregnancy or menopause, or pathological. The menstrual cycle is controlled by the hypothalamus, pituitary gland, ovaries, and outflow tract. Amenorrhea is classified as primary or secondary. Primary amenorrhea refers to the failure to start menstruation by age 16, while secondary amenorrhea is the absence of periods for 6 months in a previously regular woman. Causes can include problems of the hypothalamus, pituitary gland, ovaries, outflow tract, or endocrine issues. A thorough history, exam, and targeted testing can help determine the et
This document discusses primary amenorrhea, defined as the absence of menstruation by age 15 with normal secondary sexual characteristics or by age 13 without normal secondary sexual characteristics. It classifies amenorrhea as physiological, pathological, primary, or secondary. Causes of primary amenorrhea include anatomical abnormalities, hypergonadotropic hypogonadism, hypogonadotropic hypogonadism, and asynchronous pubertal development. Specific anatomical causes discussed in more detail include imperforate hymen, transverse vaginal septum, cervical atresia, and Mayer-Rokitansky-Kuster-Hauser syndrome. The document outlines the evaluation, history, exam findings, and investigations for a patient presenting
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.
This clinical document summarizes guidelines for evaluating and managing amenorrhea. It presents a case study of a patient with primary amenorrhea and pseudohermaphroditism. It then provides definitions of primary and secondary amenorrhea and outlines an approach for diagnosis involving history, physical exam, ultrasound, and laboratory tests. Common causes of amenorrhea are identified and diagnostic and management guidelines are presented.
This document discusses guidelines for evaluating amenorrhea in adolescents and women. It recommends initiating an evaluation by age 15-16 if normal development is present, age 13 if secondary sexual characteristics are absent, or within 2 years of breast development if menarche has not occurred. Amenorrhea is classified as primary if periods never started or secondary if absent for 3-6 months. Causes can include abnormalities of the reproductive tract, hypothalamic-pituitary issues, or ovarian problems. Treatment depends on the underlying cause and may involve hormone replacement, surgery, or assisted reproduction.
Secondary amenorrhea is the absence of menses for more than three cycles or six months in women who previously had menses. Pregnancy is the most common cause. The document outlines the step-by-step process for evaluating secondary amenorrhea, including ruling out pregnancy, assessing medical history, performing a physical exam, basic lab tests, and follow-up testing and evaluation if initial results require further investigation. Treatment options are provided for common causes like hyperprolactinemia, ovarian failure, hyperandrogenism, and Asherman's syndrome.
Amenorrhea is the abnormal absence of menstruation. It is classified as primary or secondary. Primary amenorrhea occurs when menstruation does not start by age 15-16. Secondary amenorrhea is when established menstruation stops for 3-6 months. Causes can include issues with the hypothalamus, pituitary gland, ovaries, or uterus. Diagnosis involves blood tests and imaging to determine the underlying cause. Treatment depends on the specific cause but may include hormone therapy.
1. Amenorrhea is classified as primary or secondary. Secondary amenorrhea is the cessation of menses for 6 months or more in a woman who previously had menstruation.
2. Causes of secondary amenorrhea include hypogonadotropic (decreased FSH and LH), hypergonadotropic (increased FSH and LH), and eugonadotropic (normal FSH and LH) types. Specific causes include hypothalamic or pituitary disorders, polycystic ovary syndrome, premature ovarian failure, and anatomical defects.
3. Prolonged hypogonadism from secondary amenorrhea can lead to decreased bone mineral density
This document discusses amenorrhea, which is the absence of menstruation. It describes physiological amenorrhea that occurs before puberty, during pregnancy and breastfeeding, and after menopause. It also describes pathological amenorrhea, including primary amenorrhea which is the absence of menstruation without previously established cycles, and secondary amenorrhea which is the absence of menstruation for 3-6 months in women with previous regular cycles. It provides classifications and potential causes of primary and secondary amenorrhea, as well as evaluations and treatments.
This document discusses different types of amenorrhea, or absent menstrual periods. It describes primary amenorrhea, which is the absence of menstruation by age 16 with no development of secondary sex characteristics. This can be caused by hypogonadotropic or hypergonadotropic hypogonadism. Hypergonadotropic amenorrhea is often due to genetic conditions like Turner's syndrome or enzyme deficiencies. Hypogonadotropic amenorrhea has causes like Kallmann's syndrome, infections, or pituitary tumors. Treatment depends on the underlying cause and may include hormone replacement, surgery, or removal of obstructions. Anorexia nervosa can also cause amenorrhea due to severe weight loss and altered
The document discusses abnormal menstruation and amenorrhea. It defines different types of amenorrhea and outlines the basic principles of menstrual function involving 4 compartments - the central nervous system, anterior pituitary, ovary, and uterus. Common causes of amenorrhea are then reviewed for each compartment, including disorders of the ovaries, pituitary, hypothalamus, and uterus. The diagnosis and treatment of different types of amenorrhea are also summarized.
Guidelines For Management Of Adolescent PCOSMohammad Emam
The document provides guidelines for managing adolescent polycystic ovarian syndrome (PCOS), outlining a framework that includes identifying at-risk children, accurately diagnosing adolescent PCOS based on updated criteria from ESHRE 2018, and managing symptoms while preventing long-term consequences through lifestyle modifications and screening for issues like cardiovascular risk, diabetes, depression, and sleep apnea.
Menstrual dysfunction can occur due to issues with the hypothalamus, pituitary, ovary, or outflow tract. Amenorrhea is the absence of menstruation and can be primary, secondary, physiological, or pathological. Specific causes of amenorrhea include issues with the hypothalamus, pituitary, ovaries, or uterus. Polycystic ovarian syndrome is a common cause of amenorrhea and irregular periods characterized by cysts on the ovaries and increased male hormones.
This clinical guideline outlines an approach for evaluating and managing amenorrhea. Amenorrhea is classified as primary or secondary. The workup involves excluding pregnancy, cryptomenorrhea, and obtaining a history, physical exam, and ultrasound. Patients are categorized based on secondary sex characteristics, androgen levels, and test results to identify endocrine abnormalities. Management aims to restore ovulation if possible or provide hormone replacement therapy to prevent health issues. Frequent reevaluation is important given the various potential causes.
This document provides an overview of amenorrhea, beginning with definitions and classifications of primary and secondary amenorrhea. It then discusses the pathophysiology of the hypothalamic-pituitary-ovarian axis and menstrual cycle. The main causes of amenorrhea are outlined, including physiological causes as well as disorders of the hypothalamus, pituitary, thyroid, adrenals, ovaries, and uterus. The document describes the clinical evaluation of amenorrheic patients, including taking a thorough medical history and conducting a physical exam and laboratory investigations. Finally, medical and surgical treatment options are presented depending on the underlying cause of the amenorrhea.
The document provides clinical guidelines for evaluating and managing amenorrhea. It discusses the different types of amenorrhea including primary and secondary. For evaluation, it recommends taking a medical history, physical exam, ultrasound exam, and lab tests to identify potential causes. Common causes discussed include polycystic ovary syndrome, thyroid issues, eating disorders, excessive exercise, and genetic conditions. Treatment depends on the underlying cause but may include hormone replacement therapy or lifestyle changes.
Primary amenorrhea refers to the absence of menstruation. It can be caused by physiological or pathological factors. A thorough evaluation includes obtaining a medical history, physical exam, and diagnostic tests. The history aims to understand pubertal development and identify potential causes like genetic conditions, while the exam evaluates secondary sexual characteristics and external genitalia. Key tests involve hormonal profiles to classify amenorrhea as eugonadotropic, hypergonadotropic, or hypogonadotropic. Further tests like ultrasound, MRI and karyotyping help diagnose conditions like Müllerian agenesis or Turner syndrome. The goal is to understand the underlying pathology and provide appropriate treatment.
This clinical guideline outlines an approach for evaluating and managing amenorrhea. It defines primary and secondary amenorrhea and discusses various pathophysiologies including anovulatory and ovulatory causes. The approach involves obtaining a thorough history, physical exam, and initial tests to rule out pregnancy and cryptomenorrhea. Based on exam and test results, patients are categorized to guide further workup and diagnosis of conditions like hypothalamic-pituitary dysfunction, PCOS, ovarian failure, mullerian agenesis, and congenital adrenal hyperplasia. Management aims to restore ovulation if possible or provide hormone replacement therapy to prevent health issues from estrogen deficiency. Frequent re-evaluation is often needed given the complexity of
This document discusses amenorrhea, including definitions, pathophysiology, diagnostic approach, and management. Primary amenorrhea is defined as the absence of menarche by age 16 with pubertal development or by age 14 without pubertal development. Secondary amenorrhea is the absence of menstruation for 3 or more months in a previously menstruating woman. The diagnostic approach involves obtaining a thorough history, physical exam, and ultrasound to rule out pregnancy and cryptomenorrhea before classifying the patient based on endocrine abnormalities. Management aims to restore ovulatory cycles if possible or replace estrogen when deficient, with periodic progestogen to protect the endometrium.
The document discusses amenorrhea, which is the absence or abnormal cessation of menstruation. It defines physiological and pathological amenorrhea and describes the classification and etiology of primary and secondary amenorrhea. Primary amenorrhea refers to the absence of menstruation by age 16, while secondary amenorrhea is the cessation of established menses for over 6 months. Common causes include hypothalamic-pituitary-ovarian dysfunction, congenital abnormalities, pregnancy, and thyroid or weight issues.
amenorrhea is a condition when female do not have regular mensural cycles by puberty or due to any causes this ppt can help the patient and nurses to gain knowledge about this disease process and apply their knowledge into their clinical practices
The document discusses amenorrhea, which is the absence or abnormal cessation of menstruation. It can be physiological, such as during pregnancy or menopause, or pathological. The menstrual cycle is controlled by the hypothalamus, pituitary gland, ovaries, and outflow tract. Amenorrhea is classified as primary or secondary. Primary amenorrhea refers to the failure to start menstruation by age 16, while secondary amenorrhea is the absence of periods for 6 months in a previously regular woman. Causes can include problems of the hypothalamus, pituitary gland, ovaries, outflow tract, or endocrine issues. A thorough history, exam, and targeted testing can help determine the et
This document discusses primary amenorrhea, defined as the absence of menstruation by age 15 with normal secondary sexual characteristics or by age 13 without normal secondary sexual characteristics. It classifies amenorrhea as physiological, pathological, primary, or secondary. Causes of primary amenorrhea include anatomical abnormalities, hypergonadotropic hypogonadism, hypogonadotropic hypogonadism, and asynchronous pubertal development. Specific anatomical causes discussed in more detail include imperforate hymen, transverse vaginal septum, cervical atresia, and Mayer-Rokitansky-Kuster-Hauser syndrome. The document outlines the evaluation, history, exam findings, and investigations for a patient presenting
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.
This clinical document summarizes guidelines for evaluating and managing amenorrhea. It presents a case study of a patient with primary amenorrhea and pseudohermaphroditism. It then provides definitions of primary and secondary amenorrhea and outlines an approach for diagnosis involving history, physical exam, ultrasound, and laboratory tests. Common causes of amenorrhea are identified and diagnostic and management guidelines are presented.
Amenorrhea is the absence of menstrual periods. Primary amenorrhea refers to the absence of periods by age 14 with no secondary sex changes, or by age 16 regardless of sex changes. Secondary amenorrhea is the absence of periods for 3 or more cycles or 6 months in women with previous regular cycles. Common causes include pregnancy, hypothalamic or pituitary disorders, PCOS, and eating disorders like anorexia nervosa. Workup involves medical history, physical exam, and lab tests of hormones and imaging to determine the underlying cause and guide treatment.
This document discusses female infertility, including definitions of primary and secondary infertility, common causes, and initial investigations for infertile couples. It covers testing for ovulation and tubal patency, as well as the roles of laparoscopy and hysteroscopy. Tests of ovulation include LH kits, progesterone assays, basal body temperature tracking, examining cervical mucus, and transvaginal ultrasounds. Tests of tubal patency comprise hysterosalpingography, laparoscopy with dye tests, and sonohysterosalpingography.
A 33-year-old Omani woman presented with severe lower abdominal pain for 3 days after undergoing ICSI (intra-cytoplasmic sperm injection) treatment for primary infertility. She has a history of infertility for 6 years, including a failed IUI (intrauterine insemination) treatment 2 years ago. A physical exam and medical history were taken. The woman has been experiencing primary infertility for 6 years despite various fertility treatments.
This document discusses infertility evaluation and treatment. It begins by outlining factors to consider before trying to conceive and describing methods for timing intercourse. Common causes of infertility include problems with ovulation, male factor issues, and tubal or uterine abnormalities. Treatment options range from lifestyle changes to assisted reproductive technologies like intrauterine insemination, ovulation induction, and in vitro fertilization. While assisted reproduction can help many couples conceive, it may also lead to multiple births and there are still some unknown risks for children conceived through these methods.
This document discusses female infertility, including its causes, risks, and treatment options. It defines infertility as the inability to conceive after 12 months of unprotected sex. Common causes include physical obstructions in the reproductive system from conditions like endometriosis, hormonal imbalances, fertilization issues, and problems in early embryonic development. Lifestyle factors like age, stress, smoking, and weight can also impact fertility. Treatment may involve medication, surgery, artificial insemination, or assisted reproductive technologies like IVF. Adoption and counseling are recommended for coping with infertility.
This document provides an overview of amenorrhea, including:
1. Definitions of primary and secondary amenorrhea and classifications based on cause and presentation.
2. Requirements for normal menstruation including a coordinated neuroendocrine axis and patent reproductive tract.
3. Causes of pathological amenorrhea including hypothalamic-pituitary disorders, gonadal dysgenesis, weight changes, and structural abnormalities of the reproductive tract.
This document discusses age estimation through analysis of bone development visible on x-rays. It begins by describing the different types of bones and how they develop. Next, it reviews early studies on using bone age to determine chronological age. It then discusses factors like race, nutrition, and climate that can cause variation between populations. The document proceeds to examine bone development timelines from several studies and populations. It concludes by outlining the typical chronological order of appearance and fusion of epiphyses in males and females.
Infertility is defined as the inability to conceive after one year of unprotected intercourse. It affects approximately 15% of reproductive couples. Both male and female factors contribute to infertility, with abnormal spermatogenesis and anatomic defects being the most common causes in men and women, respectively. A thorough evaluation includes history, physical exam, semen analysis, ovulation testing, and imaging to determine the underlying cause so that appropriate treatment can be initiated. Unexplained infertility accounts for 10-20% of cases.
This document provides information on Dr. Rupal N Shah, an experienced gynecologist and IVF consultant in Surat, India. It discusses her qualifications and experience in advanced infertility treatment, endoscopic surgeries, and her roles teaching and publishing on health topics. The rest of the document focuses on summarizing Dr. Shah's presentation on the uses of ultrasonography in infertility, including evaluating ovarian reserve, follicular development, polycystic ovary syndrome, ovarian cysts, uterine anomalies, and endometrial thickness.
This document discusses bone age assessment and skeletal maturity. It begins by explaining that bone age assessment is used to evaluate growth and diagnose endocrine disorders. It then describes the processes of endochondral and intramembranous ossification that govern bone development. Several key indicators of skeletal maturity are highlighted for different age groups from infancy to post-puberty. Bone age assessment is used to diagnose growth disorders and predict final adult height.
This document discusses infertility, including its definition, causes, evaluation, and treatment options. It begins by defining primary and secondary infertility and outlining the requirements for conception. Common causes of infertility for both men and women are then described. The document provides details on evaluating infertility, including medical history, physical exams, lab tests, and procedures like semen analysis and hysterosalpingography. Treatment options are covered, such as ovulation induction, surgery, assisted reproductive technologies like IUI, IVF, and surrogacy. The emotional impact of infertility is also addressed.
This document discusses methods for assessing skeletal age through radiographic examination of bones and structures. It describes using hand-wrist radiographs according to Greulich and Pyle's atlas to determine skeletal age based on ossification patterns. Cervical vertebrae morphology is also assessed in six stages of maturation. Additional methods examined are frontal sinus size relative to growth velocity and midpalatal suture approximation correlated to hand-wrist development. Skeletal age assessment provides a more reliable indicator of maturation than chronological age alone for orthodontic treatment planning.
Infertility affects couples worldwide, with an average incidence of about 15%. Evaluation of both female and male partners is essential to determine the cause, which can be female factors, male factors, or a combination. Treatment options depend on the cause and range from ovulation-inducing drugs, surgery, and assisted reproductive technologies like in vitro fertilization.
This document discusses menstrual disorders and their management. It defines conditions like menorrhagia, dysmenorrhea, and amenorrhea. It emphasizes taking a thorough history and physical exam to determine the cause and guide appropriate testing. For abnormal bleeding, it is important to determine if the bleeding is ovulatory or anovulatory. Treatment involves medical options like hormones or IUDs, or surgical procedures if medical management fails. Amenorrhea requires evaluating for problems of the hypothalamic-pituitary-ovarian axis, chronic illnesses, or structural issues.
PPH.Presented by
Ahmed Mukhtar Ali Mohammed
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
Secondary amenorrhea is the absence of menstrual periods for 6 months in a woman who had previously been regular. Common causes include pregnancy, thyroid disorders, hyperprolactinemia, medications, and functional hypothalamic amenorrhea due to conditions like anorexia. Evaluation involves testing for pregnancy and checking hormone levels like TSH, FSH, LH and prolactin. Further tests may include a progesterone challenge, ultrasound, or MRI if pituitary or ovarian issues are suspected. Treatment depends on the underlying cause but may involve hormone therapy, lifestyle changes, fertility treatments or surgery.
The document discusses hypothalamic-pituitary disorders including hypopituitarism and hyperpituitarism. It describes the anatomy and functions of the hypothalamus and pituitary gland, and their roles in regulating hormone production and release. Specific disorders covered include Sheehan's syndrome, a condition caused by postpartum necrosis of the pituitary gland, and its signs, causes, diagnosis, and treatment involving hormone replacement therapy. Pituitary dwarfism, another hypopituitarism disorder, is also summarized.
Hormone replacement therapy outlines the definitions, physiological changes, symptoms, diagnosis, and treatment options associated with menopause. It discusses indications and contraindications for HRT and provides details on different HRT regimens. Side effects of estrogen and progestogen are listed. Large studies on HRT like the Heart and Estrogen/Progestin Replacement Study and the Women's Health Initiative Study are summarized, noting their findings on risks and benefits of HRT use.
The document provides a protocol for the management of neonatal seizures. Some key points:
- Neonatal seizures are the most common manifestation of neurological disease in newborns and can be caused by hypoxic-ischemic encephalopathy, hypoglycemia, hypocalcemia, infections, and inborn errors of metabolism.
- Immediate management of ongoing seizures involves stabilizing the neonate, treating any underlying causes like hypoglycemia, and administering anti-seizure medications like phenobarbital or phenytoin intravenously.
- Long-term management requires identifying and treating the underlying etiology as well as considering long-term prognosis. Prompt treatment of seizures is important to
The document discusses antepartum fetal monitoring techniques used to assess fetal well-being, including fetal movement counting, assessment of uterine growth, antepartum fetal heart rate testing (nonstress test), biophysical profile, and Doppler velocimetry. It describes how uteroplacental insufficiency can lead to a theoretical scheme of fetal deterioration and outlines conditions that place the fetus at risk. Details are provided on performing and interpreting the nonstress test used to detect fetal distress.
CAH is a familial disorder of adrenal steroid biosynthesis caused by a deficiency in adrenal enzymes. This leads to cortisol deficiency, increased ACTH levels, adrenocortical hyperplasia, and overproduction of intermediate metabolites. Depending on the enzymatic deficiency, patients may experience signs of mineralocorticoid deficiency or excess, virilization, or sexual infantilism. The most common type is 21-hydroxylase deficiency, which accounts for over 90% of CAH cases. Untreated patients can experience life-threatening salt wasting, ambiguous genitalia, premature puberty, and short stature.
This document discusses cesarean section (CS), including types of CS, indications for elective and emergency CS, timing of elective CS, complications, postnatal care, and mode of delivery in subsequent pregnancies. It notes that lower segment CS and classical/upper segment CS are the main types. Indications include fetal malpresentation, failure to progress in labor, and prior uterine surgery. The timing of elective CS is usually 38 weeks. Complications can be intraoperative like bleeding or postoperative like infection. Strict postnatal care including monitoring is important. Vaginal delivery may be possible in subsequent pregnancies if certain criteria are met like a previous low transverse incision and no other risk factors.
This document discusses epilepsy in women and how it relates to their hormonal cycles and life stages. Key points include:
- Hormonal changes during puberty, menstruation, pregnancy, and menopause can impact seizure frequency in women. Estrogen is generally pro-convulsant while progesterone is anti-convulsant.
- Conditions like catamenial epilepsy cause seizures to cluster around a woman's menstrual period due to hormonal fluctuations.
- Fertility and menstrual disorders are more common in women with epilepsy, sometimes due to seizures themselves and sometimes due to antiepileptic drug treatment. Proper management of epilepsy and medications is important for women's health and well-being.
Renal disease in pregnancy can cause complications for both the mother and fetus. Physiological changes in pregnancy include dilatation of the ureters and renal calyces as well as increased renal plasma flow and glomerular filtration rate, leading to higher levels of urinary protein and creatinine excretion. Urinary tract infections are more common in pregnancy and can cause maternal and neonatal morbidity if not properly treated. Chronic renal disease in pregnancy carries risks of preeclampsia, intrauterine growth restriction, and premature delivery that depend on the severity of renal impairment and presence of hypertension or proteinuria. Close monitoring and multidisciplinary management are important to optimize outcomes.
This document provides an introduction to obstetric anesthesia. It discusses how the anesthetist is responsible for maintaining the physiology of both the mother and fetus during childbirth. The anesthetist must understand and account for alterations in the mother's physiology, anatomy, and pharmacology that occur during pregnancy and delivery. This includes changes to organ function, muscle tone, circulation, respiration and more. Providing anesthesia for childbirth also carries certain risks that the anesthetist must be prepared for, such as potential complications related to the dual physiology of mother and fetus. Effective communication with obstetricians is important to achieve the best outcomes.
This document discusses polycystic ovarian syndrome (PCOS) in non-obese women. PCOS is characterized by polycystic ovaries, hyperandrogenism (high androgen levels), and infrequent or absent menstrual periods. It affects around 5-6 million reproductive-aged American women. The document examines various markers and interventions for PCOS, including metformin, oral contraceptives, clomiphene citrate, supplements like inositol and vitamin D, omega-3 fatty acids, IVF combined with metformin, laparoscopic ovarian drilling, diet and exercise, and their effects on hyperandrogenism, ovulation, insulin resistance, and other symptoms. The health and economic burdens of PCOS
Preeclampsia and eclampsia are hypertensive disorders of pregnancy characterized by new onset hypertension and proteinuria after 20 weeks of gestation. Preeclampsia can progress to eclampsia, defined as tonic-clonic seizures in a pregnant woman unrelated to other causes. Delivery is the only cure for both conditions, as terminating the pregnancy resolves the symptoms. Management involves controlling blood pressure, monitoring the mother and fetus, and prompt delivery if the condition worsens or fetal well-being is threatened.
Preeclampsia and eclampsia are hypertensive disorders of pregnancy characterized by new onset hypertension and proteinuria after 20 weeks of gestation. Preeclampsia can progress to eclampsia, defined as tonic-clonic seizures in a pregnant woman unrelated to other causes. Delivery is the only cure for both conditions, as termination of pregnancy resolves symptoms. Management involves controlling blood pressure, preventing seizures, monitoring the mother and fetus, and timely delivery.
Subfertility, or difficulty conceiving, affects 15% of couples. It is defined as failure to conceive after one year of unprotected intercourse. There are several potential causes of subfertility, including problems with ovulation, sperm production/function, tubal damage, cervical factors, or sexual function. A thorough history, examination, and testing of both partners is needed to identify the underlying cause so appropriate treatment can be initiated.
This document discusses cesarean section (CS), including types (lower segment and classical), indications for elective and emergency CS, timing of elective CS, procedures before emergency CS, complications, postnatal care, mode of delivery in subsequent pregnancies, criteria for vaginal birth after cesarean (VBAC), conduct of labor for VBAC, scar rupture, and abnormal labor/dystocia. It notes that CS is most commonly indicated for dystocia or failure to progress in labor, which can be due to abnormalities of the birth canal, passenger (fetus), or powers (uterine activity or maternal pushing).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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5. AMENORRHOEAAMENORRHOEA
Prof. Dr Nik Hazlina Nik HussainProf. Dr Nik Hazlina Nik Hussain
School of Medical SciencesSchool of Medical Sciences
USMUSM
6. IMPORTANCEIMPORTANCE
– MENSTRUAL DISORDERS PRESENTEDMENSTRUAL DISORDERS PRESENTED
AS THE CHIEF COMPLAINT.AS THE CHIEF COMPLAINT.
– MENSTRUAL HISTORY MUST ALWAYSMENSTRUAL HISTORY MUST ALWAYS
BE TAKEN IN FEMALE PATIENT.BE TAKEN IN FEMALE PATIENT.
MENSTRUALMENSTRUAL
ABNORMALITIESABNORMALITIES
7. DISORDERSDISORDERS
–1)1) AmenorrhoeaAmenorrhoea- absence of- absence of
menstruation for 6 months ormenstruation for 6 months or
moremore
–2)2) Excessive/ MenorrhagiaExcessive/ Menorrhagia --
bleed more than usual amountbleed more than usual amount
regularly or irregularlyregularly or irregularly
–3)3) DysmenorrhoeaDysmenorrhoea - pain- pain
associated with menstruationassociated with menstruation
MENSTRUALMENSTRUAL
ABNORMALITIESABNORMALITIES
9. AMENORRHOEAAMENORRHOEA
PRIMARY AMENORRHOEAPRIMARY AMENORRHOEA
– No mensesNo menses
– AgeAge 14 years14 years oldold
– Absent secondary sexualAbsent secondary sexual
characteristicscharacteristics
– OROR
– No mensesNo menses
– AgeAge 16 years16 years oldold
– Normal secondary sexualNormal secondary sexual
characteristicscharacteristics
15. CNS AmenorrhoeaCNS Amenorrhoea
I) Psychogenic AmenorrhoeaI) Psychogenic Amenorrhoea
– e.g. change in environment is stressfule.g. change in environment is stressful
– Mx. Requires early and simpleMx. Requires early and simple
reassurancereassurance
– Good patient -doctor relationshipGood patient -doctor relationship
importantimportant
– No response after 6/12 of psychologicalNo response after 6/12 of psychological
therapy ,consider hormonal therapytherapy ,consider hormonal therapy
– In case desiring pregnancy, require toIn case desiring pregnancy, require to
investigate causeinvestigate cause
16. II) Exercise amenorrhoeaII) Exercise amenorrhoea
– 20%20%
– due to imbalance calorie intakedue to imbalance calorie intake
against energy expenditureagainst energy expenditure
– increased FSH/LH and variableincreased FSH/LH and variable
oestrogenoestrogen
– may need ERT,may need ERT,
OCP,Provera/ProgestogenOCP,Provera/Progestogen
CNSCNS
Amenorrhoea(cont.)Amenorrhoea(cont.)
17. III) Anorexia nervosaIII) Anorexia nervosa
–purpose not eatingpurpose not eating→→ DietDiet
–young girl or artist ,try toyoung girl or artist ,try to
keep trend with the fashionkeep trend with the fashion
–very thinvery thin
CNSCNS
Amenorrhoea(cont.)Amenorrhoea(cont.)
18. Anorexia nervosaAnorexia nervosa
Diagnostic criteriaDiagnostic criteria
age under 25 yearsage under 25 years
Anorexia with weight loss of 25%Anorexia with weight loss of 25%
original B.W.original B.W.
A distorted body image andA distorted body image and
obsessive eatingobsessive eating
No other psychiatric problemNo other psychiatric problem
19. At least 2 following complications:At least 2 following complications:
– lanugo hairlanugo hair
– amenorrhoeaamenorrhoea
– bradycardiabradycardia
– periods of overactivityperiods of overactivity
– bulimiabulimia
– vomitingvomiting
AnorexiaAnorexia
nervosa(cont.)nervosa(cont.)
20. A loss of weight of 10-15% ofA loss of weight of 10-15% of
normal weight for height lead tonormal weight for height lead to
amenorrhoeaamenorrhoea
In West- prevalence in pubertalIn West- prevalence in pubertal
females is about 1: 200females is about 1: 200
need multidisplinary approachneed multidisplinary approach
Rx.-regain weightRx.-regain weight
AnorexiaAnorexia
nervosa(cont.)nervosa(cont.)
21. 2) Pituitary causes2) Pituitary causes
–Sheehan’s syndromeSheehan’s syndrome
–HyperprolactinemiaHyperprolactinemia
–PituitaryPituitary
Tumours(Prolactinoma)Tumours(Prolactinoma)
Causes of AmenorrhoeaCauses of Amenorrhoea
22. Pituitary causesPituitary causes
I) Sheehan’s syndromeI) Sheehan’s syndrome
– infarction of pituitary due to severeinfarction of pituitary due to severe
APHAPH or more commonlyor more commonly PPHPPH
– enlarged pituitary duringenlarged pituitary during
pregnancy,sensitive to ischaemiapregnancy,sensitive to ischaemia
– clinical manifestation seen whenclinical manifestation seen when
75% of gland destruction75% of gland destruction
23. Clinical picture of Sheehan’s:Clinical picture of Sheehan’s:
– amenorrhoeaamenorrhoea
– absence of lactationabsence of lactation
– loss of energy, fatigueloss of energy, fatigue
– hypotensionhypotension
– features of oestrogen lackfeatures of oestrogen lack→→ lossloss
of pubic and axillary hair, loss ofof pubic and axillary hair, loss of
weightweight
Pituitary causes(cont.)Pituitary causes(cont.)
24. – Diagnosis of Sheehan’s syndromeDiagnosis of Sheehan’s syndrome
peripartum events in historyperipartum events in history
↓↓ FSH,LH , Prolactin, OestradiolFSH,LH , Prolactin, Oestradiol
– Treatment:Treatment:
ERT( Oestrogen replacement therapy)ERT( Oestrogen replacement therapy)
If pregnancy desired , need ovulationIf pregnancy desired , need ovulation
induction .induction .
L-thyroxine may be neededL-thyroxine may be needed
Corticosteroid if adrenals impairedCorticosteroid if adrenals impaired
Pituitary causes(cont.)Pituitary causes(cont.)
25. II) ProlactinomasII) Prolactinomas
most commonly occuringmost commonly occuring
pituitary tumourspituitary tumours
microprolactinomas- < 10 mmmicroprolactinomas- < 10 mm
diameterdiameter
macroprolactinomas-> 10 mmmacroprolactinomas-> 10 mm
diameter together with pituitarydiameter together with pituitary
sellar destructionsellar destruction
Pituitary causes(cont.)Pituitary causes(cont.)
26. Prolactinoma(Investigations)Prolactinoma(Investigations)
– Serum ProlactinSerum Prolactin
– TFTTFT
– Renal profileRenal profile
– MRI to see the pituitary fossa forMRI to see the pituitary fossa for
suprasellar involvement &tumoursuprasellar involvement &tumour
– visual field ( bitemporalvisual field ( bitemporal
hemianopia )hemianopia )
Pituitary causes(cont.)Pituitary causes(cont.)
27. Prolactinoma(Treatment)Prolactinoma(Treatment)
– whether micro or macroadenoma , thewhether micro or macroadenoma , the
primary mode of treatment is –primary mode of treatment is –
Bromocriptine or Cabergoline/ Dostinex.Bromocriptine or Cabergoline/ Dostinex.
– Normalisation of PRL in 75%Normalisation of PRL in 75%
– Shrinkage of tumour size in 70%Shrinkage of tumour size in 70%
– In pregnancy, macroadenoma mayIn pregnancy, macroadenoma may ↑↑ inin
size causing temporary blindnesssize causing temporary blindness
– check visual field regularlycheck visual field regularly
Pituitary causes(cont.)Pituitary causes(cont.)
31. Ovarian cong. defectsOvarian cong. defects
– II) Androgen insensitivityII) Androgen insensitivity
– Absence of androgen receptorsAbsence of androgen receptors
during embryonic sexualduring embryonic sexual
developmentdevelopment→→ male fetusmale fetus
develops as femaledevelops as female
– Elevated FSH, LH, Testosterone,Elevated FSH, LH, Testosterone,
– Karyotype 46 XYKaryotype 46 XY
OvarianOvarian
Diseases(cont.)Diseases(cont.)
32. B) Premature ovarian failureB) Premature ovarian failure
– cessation of menses at young agecessation of menses at young age
< 40< 40
– Elevated FSH, LHElevated FSH, LH
– Idiopathic , autoimmune,Idiopathic , autoimmune,
chemotherapy radiotherapy orchemotherapy radiotherapy or
inflammationinflammation
– Rx. - by HRTRx. - by HRT
OvarianOvarian
Diseases(cont.)Diseases(cont.)
33. C) PCOSC) PCOS
– characterized by chronic anovulationcharacterized by chronic anovulation
and hyperandrogenismand hyperandrogenism
– Patient is obese, amenorrhoea,Patient is obese, amenorrhoea,
infertilityinfertility
– Elevated FSH& LH with LH:FSH 3:1Elevated FSH& LH with LH:FSH 3:1
– Elevated androgens( DHEASO4 andElevated androgens( DHEASO4 and
Testosterone)Testosterone)
– Rx. -C.C. to induce ovulationRx. -C.C. to induce ovulation
↓↓ body weightbody weight
OvarianOvarian
Diseases(cont.)Diseases(cont.)
34. 4) Uterovaginal diseases4) Uterovaginal diseases
– A) Imperforate hymenA) Imperforate hymen
– B) Vaginal agenesisB) Vaginal agenesis
– C) Transverse vaginal septumC) Transverse vaginal septum
– D) Ashermann’s syndromeD) Ashermann’s syndrome
– E) Cervical stenosisE) Cervical stenosis
Causes of AmenorrhoeaCauses of Amenorrhoea
35. Uterovaginal diseasesUterovaginal diseases
Ashermann’s syndromeAshermann’s syndrome
– overcurettage up to basal layer of theovercurettage up to basal layer of the
endometriumendometrium →→ will cause fibrosis, and it willwill cause fibrosis, and it will
be stucked togetherbe stucked together
– intrauterine or intracervical adhesive scarringintrauterine or intracervical adhesive scarring
e.g. overzealous D&Ce.g. overzealous D&C
– Hysterography or hysteroscopy needed forHysterography or hysteroscopy needed for
diagnosis and managementdiagnosis and management
– Surgical resection through hysteroscopeSurgical resection through hysteroscope
– Insert IUCDInsert IUCD
– HRTHRT
36. 5) Systemic illness5) Systemic illness
– A) Adrenal dysfunction-A) Adrenal dysfunction-
Cushing’s,Addison’s, HyperplasiaCushing’s,Addison’s, Hyperplasia
– B) Thyroid dysfunctionB) Thyroid dysfunction
– C) Chronic systemic diseases-C) Chronic systemic diseases-
Liver,Liver,
TB,DM,Obesity,MalabsorptionTB,DM,Obesity,Malabsorption
Causes of AmenorrhoeaCauses of Amenorrhoea
37. Tests to identify cause ofTests to identify cause of
amenorrhoeaamenorrhoea
FSH , LH- To diagnoseFSH , LH- To diagnose
hypergonadotrophic amenorrhoeahypergonadotrophic amenorrhoea
PRL - to check pituitary tumoursPRL - to check pituitary tumours
Testosterone- for PCOS and virilizationTestosterone- for PCOS and virilization
Se cortisol- for adrenal insufficiencySe cortisol- for adrenal insufficiency
Karyotyping- chromosomal abnormalityKaryotyping- chromosomal abnormality
Oestradiol- to diagnose oestrogenOestradiol- to diagnose oestrogen
deficiency.deficiency.
Ovarian biopsy( if needed)Ovarian biopsy( if needed)
38. PPAST HISTORY
N puberty milestone
Thelarche, adrenarche
Pubarche, menarche
POH
Hist. Of surgery
Cx of surgery
Medical illness
Menstrual pattern
Menopausal symtoms
Normal menstruation
In family members
AMENORRHOEAAMENORRHOEA
39. Social history Review of system Medication
Stress
Over exercise
Dieting
Headache, vomiting
Visual disturbance
Galactorrhoea
Cyclical abd. pain
Vaginal discomport
Medication
related to
amenorrhoea
AMENORRHOEA(cont.)AMENORRHOEA(cont.)
40. Breast
(galactorrhoea)
Pubic hair Axillary hair
2'SCC Thyroid BP BMI
General
CVS CNS Resp Fundoscopy
VisualField
System ic
Exam ination
AMENORRHOEA(cont.)AMENORRHOEA(cont.)
41. N o r m a l F e m a le
E x t e r n a l G e n it a lia
V u lv a
S h o r t B lin d
E n d in g V a g in a ?
V a g in a
P e lv ic
C e r v ix & u t e r u s
p a lp a b le /
a b s e n t
R e c t a l
E x a m in a t io n
AMENORRHOEA(cont.)AMENORRHOEA(cont.)
42. P r o la c t in
O e s t r a d io l
T e s t o s t e r o n e
L H
F S H
T h y r o x in e
S e r u m H o r m o n e s K a r y o t y p e
B u c c a l S m e a r
K id n e y s
O v a r ie s
U t e r u s
U lt r a s o u n d L a p a r o s c o p y
I n v e s t ig a t io n
AMENORRHOEA(cont.)AMENORRHOEA(cont.)
43. Primary AmenorrhoeaPrimary Amenorrhoea
N orm al 2" S C C P u berty d elayed / arrested
(S exual In fan tilism )
D iscord ant P u b ertal
D evelop m en t
C A U S E S
44. ……..Primary..Primary
amenorrhoeaamenorrhoea
C o n s titu tio n a l
N o rm a l
R O S
H ig h F S H
P C O S
H ig h L H /F S H
ra tio
H y p e rp ro la c tin a e m ia
H ig h P ro la c tin
F S H /L H /P ro la c tin
N o rm a l g e n ita l
tra c t
T ra n s v e rs e v a g in a l
S e p tu m
Im p e rfo ra te H y m e n
M u lle ria n A g e n e s is
A b n o rm a l
g e n ita l tra c t
N o rm a l 2 ' S C C
45. Isola ted
G o na do tro ph in d ef.
K alm an syn drom e
C o ng enital
A n orexia N e rvo sa H e avy E xercise S tre ss W e igh t lo ss
A cquired
H ypo go na dotro p hic
H ypo go dism
L ow F S H /L H
G alactosa e m ia
4 6X X
X Y A g e ne sis
X Y enzym e fa ilure
M osa ic/ de le tio n
4 6 X Y
H ig h F S H /L H
N orm a l S ta ture
A cqu ire d
( E m pty S e lla S nd ,
P ituita ry a de n o m a )
C o ng e nita l
( H yd roce ph alu s,
La w ren ce .M .B )
Intracran ial
lesio n
L o w F S H /L H
S h ort S ta tu re
( 1 47 cm )
S exu a l In fa ntilism
……..Primary..Primary
amenorrhoeaamenorrhoea
46. V a g in a +
B la d d e r +
U te r u s -
4 6 X Y
A n d r o g e n
In s e n s itiv ity
S y n d r o m e
N o r m a l
B r e a s t,
P u b ic &
A x illa r y
F e m a le P s e u d o h e m a p h r o d ite
( C A H )
4 6 X X
M a le P s e u d o h e m a p h r o d ite
4 6 X Y
N o r m a l
P u b ic &
A x illa r y
H a ir
P o o r B r e a s t
D e v e lo p m e n t
D is c o r d a n t
P u b e r ta l
D e v e lo p m e n t
……..Primary..Primary
amenorrhoeaamenorrhoea