Easy powerpoint presentation for undergraduates

1. DR ANITA RAMESH
MD,OBGY

2.  Amenorrhea means absence of menstruation
 TYPES
Physiological amenorrhea
Pathological amenorrhea
Primary amenorrhea
Secondary amenorrhea

3.  Absence of menses by the age of 14 years
with no secondary sexual characters
0R
 Absence of menses by the age of 16 years
irrespective of development of secondary
sexual characters

4.  Absence of menses for 6 months or absence
of atleast 3 of the previous 3 cycles

5.  3% to 4%
 About 10% to 20% of those with infertility
have amenorrhea

6.  Normal chromosomal pattern
 Co ordinated HPO axis
 Anatomical presence & patency of outflow
tract
 Responsive endometrium
 Active thyroid & adrenal glands

8.  Before puberty
 Pregnancy
 Lactation
 menopause

12.  Amenorrhea
 Periodic pain in the lower abdomen
 Abdominal lump
 Retention of urine

13.  Imperforate hymen:cruciate incision over
bulging hymen
 Cervical stenosis:cervical dilatation
 Transverse vaginal septum:excision of septum

14.  Hypergonadotropic hypogonadism(43%)
 Developmental defects of genital tract(30%)
 Hyogonatotropic hypogonadism(27%)
 Abnormal chromosomal pattern
 Dysfunction of thyroid or adrenal
gland(adrenogenital syndrome,cretinism)
 Metabolic disorders(juvenile diabetes)
 Systemic illnesses(malnutition,TB,weight
loss,anaemia)
 Unresponsive endometrium:uterine synchiae
due to TB

15.  Primary ovarian failure
 Resistant ovarian syndrome
 Galactosemia
 Enzyme deficiency:17 alpa hydroxylase
deficiency

16.  Mullerian agenesis or dysgenesis
 Imperforate hymen
 Transverse vaginal septum
 Atresia of upper third of vagina & cervix
 Complete absence of vagina
 Absence of uterus(MRKH)

17.  Constitutional delay:delayed GnRH pulse
activation
 HPO AXIS DYSFUNCTION:stress,weight
loss,excessive exercise,chronic
disease(TB),anorexia nervosa
 Kallmans disease(inadequate GnRH pulse
secretion
 CNS TUMOURS:craniophayngioma(reduced
Gnrh RELEASE

18.  Turner”s syndrome(45X or various mosaics)
 Pure gonadal
dysgenesis(46XX…phenotypically female with
streak gonads)
 Androgen insensitivity syndrome(testicular
feministion syndrome…46XY)
 Partial deletions of X chromosome

21.  DEVELOPMENTAL ANOMALIES
ABSENT VAGINA:Vaginoplasty before
marriage
 CHROMOSOMAL ABNORMALITIES
Turner”s syndrome:short course of E+P for
breast development
XY Gonadal dysgenesis:gonads to be
removed for preventing seminoma or
dysgerminoma

22.  Androgen insensitivity syndrome:Reared as
female only & removal of gonads.HRT with CEE
0.625 mg continued for maintainence of
secondary sexual characters
 HPO Axis defect:
Constitutional delay:reassure patient or can be
induced using E+P
Kallman”s syndrome:periods induced with
pulsatile GnRH administration
HP tumours like craniopharyngioma needs
excision or radiotheraphy

23.  Thyroid & adrenal dysfunction:
1. Cretinism:thyroid replacement theraphy
2. Adrenogenital syndrome with enlarged
clitoris needs clitoroplasty &
corticosteriods for prolonged theraphy
3. 17 alpha hydroxylase
deficiency:corticosteroid replacement
theraphy
4. Prolactinomas:dopamine agonists

24.  Metabolic & nutritional
1. Diabetes:antidiabetics
2. TB:Anti TB drugs
3. Correction of weight loss
4. Reduction of stress
 Unresponsive endometrium due to TB
Anti TB drugs,adhesiolysis & high dose E+P