amenorrhea - CLINICALGUIDELINES CLINICALGUIDELINES FOR...

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CLINICAL GUIDELINES CLINICAL GUIDELINES FOR  FOR  EVALUATION AND MANAGEMENT  EVALUATION AND MANAGEMENT  OF AMENORRHEA OF AMENORRHEA Dr. JEHAD YOUSEF FICS, FRCOG ALHAYAT ART CENTER AMMAN – JORDAN
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Definitions Primary amenorrhea Failure of menarche to occur when expected in relation to the onset of pubertal development. No menarche by age 16 years with signs of pubertal development. No onset of pubertal development by age 14 years. Secondary amenorrhea Absence of menstruation for 3 or more months in a previously menstruating women of reproductive age.
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CNS-Hypothalamus-Pituitary Ovary-uterus Interaction Neural control Chemical control Dopamine  (-) Norepiniphrine  (+) Endorphines  (-) Hypothalamus Gn-RH Ant. pituitary FSH, LH Ovaries  Uterus Progesterone Estrogen Menses ± ?
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Pathophysiology  of  Amenorrhea Inadequate hormonal stimulation of the endomerium “Anovulatory amenorrhea” - Euestrogenic - Hypoestrogenic Inability of endometrium to respond to hormones “Ovulatory amenorrhea” - Uterine absence - Utero-vaginal agenesis - XY-Females ( e.g T.F.S) - Damaged endometrium ( e.g Asherman’s syndrome)
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Euestrogenic Anovulatory Amenorrhea Normal androgens Hypothalamic-pituitary dysfunction (stress, weight loss or gain, exercise, pseudocyesis) Hyperprolactinemia Feminizing ovarian tumour Non-gonadal endocrine disease (thyroid, adrenal) Systemic illness High androgens PCOS Musculinizing ovarian tumour Cushing’s syndrome Congenital adrenal hyperplasia (late onset)
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Hypoestrogenic Anovulatory Amenorrhea Normal androgens - Hypothalamic-pituitary failure - Severe dysfunction - Neoplastic,destructive, trumatic conditions involving hypothalamus or pituitary - Ovarian failure - Gonadal dysgenesis - Premature ovarian failure - Enzyme defect - Resistant ovaries - Radiotherapy, chemotherapy High androgens - Musculinizing ovarian tumour - Cushing’s syndrome - Congenital adrenal hyperplasia (late onset)
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AMENORRHOEA AN APPROACH FOR DIAGNOSIS HISTORY PHYSICAL EXAMINATION ULTRASOUND EXAMINATION Exclude Pregnancy Exclude Cryptomenorrhea
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Cryptomenorrhea Outflow obstruction to menstrual blood - Imperforate hymen - Transverse Vaginal septum with functioning uterus - Isolated Vaginal agenesis with functioning uterus - Isolated Cervical agenesis   with functioning uterus - Intermittent abdominal pain - Possible difficulty with micturition - Possible lower abdominal swelling -  Bulging bluish membrane at the introitus or absent   vagina (only dimple)
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Imperforate hymen
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Once Pregnancy and cryptomenorrhea are  excluded : The patient is a bioassay for   Endocrine abnormalities   Four categories of patients are identified  1. Amenorrhea with absent or poor  secondary sex Characters 2. Amenorrhea with normal 2ry      sex characters 3. Amenorrhea with signs of      androgen  excess 4. Amenorrhea with absent uterus      and vagina
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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amenorrhea - CLINICALGUIDELINES CLINICALGUIDELINES FOR...

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