Transcript Amenorrhea - shsmu.edu.cn

Amenorrhea
DI WEN
M.D., Ph.D.,
Professor & Chairman
Department Of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of Medicine
Amenorrhea
• Amenorrhea is the absence of
menstruation.
• Primary
– Absence of menses by age 16 with
normal secondary sexual characteristics.
– Absence of menses by age 14 without
secondary sexual development.
• Secondary
– Absence of menses for 6 months in a
previously menstruating female.
Events of Puberty
• Thelarche (breast development)
– Requires estrogen
• Pubarche/adrenarche (pubic hair
development)
– Requires androgens
Events of Puberty
• Menarche
Requires:
– GnRH from the hypothalamus
– FSH and LH from the pituitary
– Estrogen and progesterone from the
ovaries
– Normal outflow tract
P1
P2
P3
P4
P5
Tanner’s
Classification of amenorrhea
• hypothalamic amenorrhea
• pituitary amenorrhea
• ovarian amenorrhea
• uterine amenorrhea
Etiology
• hypothalamic amenorrhea
– Psychological stress
– 5a-Reductase deficiency
– Anorexia nervosa, weight loss
– Increased exercise levels
– Kallmann syndrome
– drug-induced amenorrhea
– Space-occupying lesion of CNS
Etiology
• pituitary amenorrhea
– tumor
– Empty sella syndrome
– Sheehan syndrome
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
Tunner staging
Acanthosis nigrans
Striae
Typical features of Turner Syndrome
Etiology
• uterine amenorrhea
– Absence of uterus
– Asherman syndrome
• anatomic abnormalities of the
reproductive tract
– Imperforate Hymen
Imperforate Hymen
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-XX
• 15~30% renal, skeletal and middle
ear anomalies
Androgen Insensitivity
• Normal breasts but no sexual
hair
• Normal looking female external
genitalia
• Absent uterus and upper vagina
• Karyotype 46, XY
• Male range testosterone level
• Treatment : gonadectomy after
puberty + HRT
Diagnosis
• History
• Physical examination
– Physical examination begins
with vital signs, including
height and weight, and with
sexual maturity ratings
• Laboratory evaluation
VE- preg test
TSH ,PROLACTIN’,
Prog.challenge test
without withdrawal
bleeding
withdrawal
bleeding
hypoestrogenic
anovulation
+ve.est,progest.
challenge test
compromised
outflow tract.
-ve.est,progest
.challenge test
2wk
FSH norm.
Repeat+serum
,est.level
hypothalamicpituitary failure
Normal FSH
FSH>30-40
repeat
HSG OR hysteroscopy
asherman
PROF
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
Thanks for Your Attention
DI WEN
M.D., Ph.D.
Professor & Chairman
Department of Obstetrics & Gynecology
Renji Hospital Affiliated to SJTU School of Medicine