Amenorrhea&Anovulation

Amenorrhea&Anovulation - Amenorrhea & Anovulation...

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Andrea Chymiy, MD Swedish Family Medicine
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Amenorrhea Transient, intermittent, or permanent Results from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina
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Primary vs. Secondary Amenorrhea Primary: Absence of menarche by the age of 16. Secondary: absence of menses for  more than three cycle intervals or six  months in women who were previously  menstruating 
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Causes of Primary Amenorrhea Chromosomal abnormalities — 45% Physiologic delay of puberty — 20%  Müllerian agenesis — 15% Transverse vaginal septum or imperforate hymen —  5%  Absent hypothalamic production of GnRH - 5% Anorexia nervosa — 2% Hypopituitarism — 2%
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Diagnostic Evaluation for Primary Amenorrhea: Normal pubertal development? Was pt’s neonatal/childhood health normal? Family history of delayed/absent menarche? Any symptoms of virilization? Any galactorrhea? (hyperprolactinemia)
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More history questions… Any recent increase in stress, or change in weight,  diet, or exercise habits?  Is pt taking any meds or drugs? Short stature compared to family members?  Any symptoms of other hypothalamic-pituitary  disease (headaches, visual field defects, fatigue,  polyuria or polydipsia?)
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Physical Exam: Evaluation of pubertal development - including Pelvic exam to check for presence of cervix, uterus, ovaries (may need ultrasound) Check skin for signs of androgen excess (acanthosis  (thyroid  disorders) Check for physical features of Turner syndrome (low hair line, web neck, shield chest, and widely spaced nipples)  
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Tanner staging
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Acanthosis nigrans
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Striae
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Vitiligo
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Typical features of Turner Syndrome
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If uterus not found on exam… If normal vagina or uterus not obviously present on PE, a pelvic U/S is performed to confirm the presence or absence of ovaries, uterus, and cervix. If no uterus found, further evaluation should include a karyotype and measurement of serum testosterone .
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…and no evidence of an imperforate hymen, vaginal septum, or congenital absence of the vagina is found, an endocrine evaluation should be performed.   If signs or symptoms of hyperandrogenism,
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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&Anovulation - Amenorrhea & Anovulation...

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