Obstetrics and Gynecology for Medical Students
Amenorrhea
11
Quick facts
by Daniel Kozan
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Define primary amenorrhea.
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No menses by age 14 in absence of secondary sexual characteristics or no menses by age 16 with secondary sexual characteristics
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Define secondary amenorrhea.
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No menses after >6 months or 3 cycles after documented menarche
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Define oligomenorrhea.
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Episodic vaginal bleeding occurring at intervals >35 days
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What are some causes of amenorrhea due to hypothalamic dysfunction? (4)
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1. nutritional deprivation or exercise
2. extreme stress/systemic illness
3. hypothalamic tumor
4. congenital GnRH deficiency i.e. Kallman's syndrome (secondary hypogonadism)
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What is the classic feature of Kallman's syndrome?
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anosmia
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What are possible causes of amenorrhea due to pituitary dysfunction? (3)
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1. brain or pituitary tumor
2. Sheehan syndrome
3. primary hypopituitarism
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What is Sheehan syndrome?
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hypopituitarism due to postpartum hemorrhage
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What are some causes of amenorrhea due to ovarian dysfunction? (5)
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1. radiation, chemotherapy
2. gonadal dysgenesis i.e. Turner's syndrome (XO)
3. resistant ovary syndrome
4. menopause
5. chronic anovulation i.e. PCOS
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What are some causes of amenorrhea due to uterine or outflow tract anomalies? (5)
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1. mullerian agenesis (Mayer-Rokitansky-Kuster-Hause syndrome)
2. imperforate hymen
3. tranverse vaginal septum
4. cervical stenosis
5. intrauterine adhesions (Asherman's syndrome)
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What are some endocrine causes of amenorrhea? (4)
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1. hyperandrogenism i.e. PCOS
2. Cushing's disease
3. hyperprolactinoma
4. hyper/hypothyroidism
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Until proven otherwise, you should assume secondary amenorrhea is...
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pregnancy
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