Amenorrhea

i present this in our academic day..

1. amenorrhea
Done By : Sumayyah Juaid R2
Supervesised By : Nabeel Brasha

2. wikipedia
an abnormal absence of menstruation.
ORIGIN from Greek

3. clinically
Primary Primary Secondary Secondary

4. Classification of amenorrhea
Hypothalamic Amenorrhea
Pituitary Amenorrhea
Ovarian Amenorrhea
Uterine Amenorrhea

5. Events of Puberty
Thelarche :
• the breast development
• Requires estrogenestrogen

6. Pubarche/adrenarche :
pubic hair development
•Requires androgensandrogens
Events of Puberty

7. Menarche :
Requires:
•GnRHGnRH from the hypothalamus
•FSHFSH and LHLH from the pituitary
•Estrogen and progesteroneEstrogen and progesterone from
the ovaries
Normal outflow tract
Events of Puberty

8. functional menses
Compartment ICompartment I
outflow tract ( uterine target organ)
Compartment IICompartment II
ovary ( Estrogen & Progesterone)
Compartment IIICompartment III
Anterior Pituitary
Compartment IVCompartment IV
CNS ( Hypothalamic )

10. primary amenorrhea

11. primary amenorrhea
‣pregnancy
‣anatomical defects
‣...... 2nd ry amenorrhea
‣mullerian a-genesis
‣testicular feminaization
‣gonadal disorders
‣CNS : hypothalamic-pituitary
●
RARE

12. ✴pregnancy
✴anatomical defects :
mullerian anaomalies : imperforated hymen, vaginal
septum,
✴causes 2nd ry amenorrhea :
hypothalamic, pituitary ,ovarian ,uterine etiology

13. (Mayer-Rokitansky-Kuster-Hauser
syndrome)

15. 46 XX

16. Typical features
of
Turner SyndromeTurner Syndrome

18. hypogonadotropic
hypogonadism
✴ 2nd most common
✴ insufficient pulsatile pulsatile
secretion of GnRH secretion of GnRH →
leads to deficiencies in
FSH and LH
✴ normal height for their
age
✴ most common
✴ the lack of physical
development caused by delayed delayed
reactivation of the GnRH pulse reactivation of the GnRH pulse
generatorgenerator
✴short for their chronologic
agenormal for their bone age

19. •A craniopharyngioma is a benign tumor that
develops near the pituitary gland .
• most commonly in childhood and
adolescence and in later adult life.
compresses the pituitary stalk or gland, the
tumor can cause partial or complete pituitary
hormone deficiency.

20. 17,20 -desmolase deficincy
agonadieisim
17 alf-hydroxylase deficincy (46, XY )

22. secondary
amenorrhea
Compartment ICompartment I
outflow tract ( uterine target organ)
• pregnancy
• Asherman's Syndrome (synchiea)

23. secondary
amenorrhea
• Premature Ovarian Failure
• Resistance Ovarian Syndrome
(ovarian hypofolliculogenesis)
• Radiation & Chemotherapy .
Radiation & Chemotherapy .
Compartment IICompartment II
Ovary
(Hypergonadotropic Hypogonadism)

24. secondary
amenorrhea
•Hyper - prolactinemia
• Tumors
• Shehan Syndrome
Compartment IIICompartment III
Anterior Pituitary

25. secondary
amenorrhea
• Hypothyrodesim
• Stress anxiety
• Anorexia
• Excessive Exercise
• Drugs
Compartment IVCompartment IV
CNS ( Hypothalamic )

26. Clinical assessment
1- BHCG
2- TFT
3- Prolactin
TOP
Bottom

27. •Provera 10 mg PO once daily 7-10 days or
•Norethindrone 5 mg PO once daily for 7-10 days
or
•Progesterone 200 mg IM for one dose .
Progesterone Challenge Test :

29. •Premarin 1.25 mg orally daily for 21 days
•Oral Contraceptive for 2 Cycles
•Estradiol 2 mg orally daily for 21 days and Follow
with 7-10 days of Progesterone
estrogen progesterone challenge
test

30. step 2

31. step 3

32. thanks