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    AMENORRHOEA

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    drravindermehetrey
    This document discusses amenorrhea, or the absence of menstruation. It defines primary amenorrhea as the failure to menstruate by age 16, and secondary amenorrhea as the absence of menses for 6 months in a previously menstruating woman. The causes of amenorrhea are then categorized as hypergonadotropic, eugonadotropic, or hypogonadotropic. Various conditions are listed under each category. Signs, symptoms, investigations, and management are also outlined.

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    AMENORRHOEA

    Uploaded by

    drravindermehetrey
    51 views16 pages
    This document discusses amenorrhea, or the absence of menstruation. It defines primary amenorrhea as the failure to menstruate by age 16, and secondary amenorrhea as the absence of menses for 6 months in a previously menstruating woman. The causes of amenorrhea are then categorized as hypergonadotropic, eugonadotropic, or hypogonadotropic. Various conditions are listed under each category. Signs, symptoms, investigations, and management are also outlined.

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    This document discusses amenorrhea, or the absence of menstruation. It defines primary amenorrhea as the failure to menstruate by age 16, and secondary amenorrhea as the absence of menses for 6 months in a previously menstruating woman. The causes of amenorrhea are then categorized as hypergonadotropic, eugonadotropic, or hypogonadotropic. Various conditions are listed under each category. Signs, symptoms, investigations, and management are also outlined.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    51 views16 pages

    AMENORRHOEA

    Uploaded by

    drravindermehetrey
    This document discusses amenorrhea, or the absence of menstruation. It defines primary amenorrhea as the failure to menstruate by age 16, and secondary amenorrhea as the absence of menses for 6 months in a previously menstruating woman. The causes of amenorrhea are then categorized as hypergonadotropic, eugonadotropic, or hypogonadotropic. Various conditions are listed under each category. Signs, symptoms, investigations, and management are also outlined.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 16

    AMENORRHOEA

     Absence of Menstruation
     10 – Failure to menstruate at the onset of puberty (by
    16yrs/14yrs (Sexual Charec.) in absence of sec
     20 – Absence of menses 6 months in a woman who has
    previously been menstrually regularly
    Aetiology:
    I. Hypergonadotropic 10 Amenorrhoea
    A. Abnormal sex chromosomes
    Gonadal dysgenesis : 45 OX (TURNER, SYD);
    MOSAKS; Abnormal X.
    B. Normal sex chromosomes
     46 XX pure gonadal dysgenesis
     46 XY gonadal dysgenesis (Swyer’s syndrome)
     Gonadotropin – resistant ovary synd.;- savage syn
    II. Eugonadotropic 10 Amenorrhoea :
    A. Absent / Nonfunctional uterus
     Congenital Mullerian agenesis
     Testicular feminizing syndrome
    B. Functional Uterus
     Imperforate Hymen / Transverse vag. septum
     Vaginal atresia
    C. Adrenal / Thyroid diseases
    III. Hypogonadotropic 10 Amenorrhoea :
    A. Hypothalamic Coz’s
     Delayed Menarche
     Hypothalamic hypogonadism (Kallman’s synd.)
     Psychogenic /wt. loss
    B. Pituitary Coz’s :
    Neoplasms – Prolactinomas; Craniopharyngiomas
    Hypo pituitary states: Simmond’s disease
    Chiami – frommel syndrome & forbes – Albright
    syndrome
    C. Severe Systemic disease like T.B
    CHECK LIST OF SYMPTOMS AND SIGNS,
    AND INVESTIGATIONS IN 10
    AMENORRHOEA
    Symptoms :
    • Exogenous steroid intake
    • Family history of delayed puberty / menarche (or)
    chr. abn.
    • Social – psychological problems
    • Excessive wt. loss; dieting; vigorous exercise
    • Cyclical lower abdomen pain
    • Anosmia; headaches; visual disturbances;
    Galactorrhoea
    • Head injury; brain irradiation (or) surgery);
    Meningitis; Chemotherapy.
    • Virilising symp. – Hirsutism; change in voice.
    SIGNS:
    • Personality
    • Height
    • Nutritional status
    • 20 sex charec.
    • Acne; Hirsutism
    • Visual fields; expressible galactorrhoea
    • Turner’s synd. Features : webbing of neck;
    widely spaced nipples; pectus cavum;
    congenital heart disease.
    • Lower abdominal mass
    • Vaginal examination
    - External genitalia
    - Clitoromegaly
    - Imperforate hymen (Tr. Septum)
    - Absent / blind – ending vagina
    - Uterus & cervix (present / absent on P/R)
    General Investigations:
    • Chr. Analysis / Karyotype
    • Serum LH / FSH / Prolactin / Oestrogens &
    Androgens
    • X-Rays of wrist & metacarpal bones
    • Plain skull X-ray; coned view X-rays / CAT. of
    pituitary fossa.
    Management of 10 Amenorrhoea :
    - To initiate full reproductive potential
    - In whom fertility is impossible, Rx to allow
    adequate physical development & normal coital
    relations.
    Correction of short stature :
    Imp. Growth determinants are present on short
    & long arm of X – chromosomes
    Hence in Turner’s syndrome - short stature
     Anabolic steroids may ↑ Ht.
     Pituitary dwarfism due to isolated growth hormone
    def. if recognized for the 1st time in patient
    presenting with 10 Amenorrhoea.
    Rx with G.H. before ‘E’ & ‘P’ Rx is introduced (to
    prevent rapid epiphysial fusion)
    Correction of sexual infantilism :
    Primary breast development can be used by OC pills –
    2-3 yrs, commencing Rx around puberty.
    Surgery :
    - Neurosurgery is indicated in patients with
    craniopharyngioma & pituitary tumors.
    - In patients with XY Karyotype  Removal
    of testicular tissue.
    - Construction of an artificial vagina with
    isolated vaginal atresia.
    - Cryptomenorrhoea with imperforate hymen –
    Cruciate incision.
    ETIOLOGY OF SECONDARY
    AMENORRHOEA
    I. CRANIUM:
    1. Hypothalamus: - Wt. change
    - Anorexia nervosa
    - Vigorous exercise
    - Stress – anxiety
    • Drugs : - Phenothiazines
    - Morphine
    - Methyl d & a
    - Reserpine
    - Antihistamines
     Hyperprolactinemia; amenorrhoea – galactorrhoea synd.
     PCOD
     Intracranial supra-sellar tumours – Craniopharyngioma
    - Glioma
    - Sec. malignancy
    2. Pituitary Gland:
    • Tumors: Prolactinomas
    • Necrosis (Sheeharis syndrome)
    • Empty – sella synd.
    II. OVARY :
    1. Premature ovarian failure
    • True premature menopause
    • Auto-immune
    • Radiotherapy
    • Chemotherapy
    2. Functioning ovarian tumors – Virilising tumors.
    III. UTERUS : Asherman’s synd
    Tubercular endometritis
    IV. General : - Hyperthyroidism
    - Chronic renal failure
    - Chronic liver disease
    Symptoms : - Use of OC pills
    - Pregnancy
    - Lactation
    - H/o Hysterectomy
    - Wt loss, stress, vig exercise, Anorexia
    nervosa.
    - Visual disturbances, anosmia
    galactorrhoea
    - Family H/o premature menopause
    - Hot flushes
    - Drugs
    - H/o PPH
    - Curellage
    - Radiotherapy / Chemotherapy
    - Hirsutism
    - T.B. / Thyroid / Renal / Liver disease
    Signs : - Psychological status
    - Wt. Nutritional status
    - Visual fields, galactorrhoea, fundoscopy
    - Features of Turner’s synd; Hypo /
    Hyperthyroidism. Chr. Renal / Liver disease /
    Cushing's disease Hypo pituitaries
    - Acne / Hirsutism; loss of axillary pubic hair
    - Vaginal examination: Clitoromegaly
    Atrophy of vulva & vaginal skin
    Uterine size
    Ovarian tumor
    Rx :
    1. Severe Anorexia Nervosa combined management
    with psychiatrist. Hospitalization for 2-3 months.
    2. Temp. derangement of Neuro endocrine system
    due to stressful states connection of
    Social & domestic problem underlying
    cause
    SURGERY :
    Intracranial surgery: 1. Craniopharyngioma
    2. Cushing’s synd due to
    pituitary adenoma
    3. Macroadema
    (Prolactinoma)
    Bilateral Ov. wedge Resection – PCOD
    Surgical excision – Virilising tumors
    Hysteroscopic lysis of intrauterine adhesions
    insertion of IUCD
    Investigations :
    Prog. Challenge test

    +ve -ve
    Anovulation 1. Low end. Estrogen
    2. Non func. end
    3. Out flow obstruct
    4. Absent uterus.

    Oestrogen challenge test

    +ve 2. Non func. end.


    1. (Low end. oestrogen) 3. Out flow obst.
    Cst. FSH 4. Absent uterus
    LH
    (OV. Failure) (H-P failure)

    Karyotype Sr. Prolactin


    (N) /

    - X-Ray GnRH challenge test


    - CAT scan of pituitary fossa
    + -
    Hypothalamic defect Pituitary defect

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