Amenorrhea

Topic of presentation: Amenorrhea. Content includes: Introduction, Etiology, signs and symptoms, classification, diagnosis and management with treatment. How it can be prevented. Both the types: Primary and secondary are discussed.

1. Obstetrics and Gynecology AMENORRHEA Dr.Muhammad Zaid #Obstetricsandgynecologydiseases

2. AMENORRHEA Amenorrhea is the absence of menstruation. It can be either primary or secondary. Criteria •No menses in 3 months if regular •No menses in 6 months if irregular

3. A menorrhea Lifestyle factors •Low body weight ( BMI <19) •Excessive exercise •PCOS •THYROID DISORDER •Gonadal agensis •Gonadal dysgenesis •Endometrial hyperplasia •Infertility Structural problems Hormonal imbalance Complications Important facts

4. T he lack of estrogen release by the ovary can lead to the appearance of the following clinical manifestations: •Alterations of the emotional state. •Sleep disturbances. •Decreased libido. •Vaginal dryness and consequently painful sexual intercourse. •Hair loss. •Headache Signs and Symptoms of Amenorrhea

5. Primary Amenorrhea Secondary amenorrhea is the absence of menses for more than 3 months in a female who menstruates regularly or absence of menses for 6 months in a female who menstruates irregularly. Primary amenorrhea is defined as the absence of menstruation by the age of 15years in a female who has normal secondary sexual characteristics. If a girl has not developed secondary sexual characteristics by age 13, begin a workup for primary amenorrhea. Types Secondary Amenorrhea

6. Causes of Primary Amenorrhea MÜLLERIAN AGENESIS

7. Gonadal dysgenesis •Abnormal sex chromosome (Turner’s XO) • Normal sex chromosome (46XX, 46XY)

8. Polycystic Ovarian Syndrome Other causes of PRIMARY AMENORRHEA: •Delay of puberty •Hypopituitarism

9. β- HCG Diagnosis Prolactin TSH FSH Pelvic Ultrasound ( assessment of presence of uterus)

10. Treatment of 1° Amenorrhea Androgen insensitivity syndrome TX : • Gonadal resection after puberty •Psychological counselling •Creation of neo-vagina Anatomical • Imperforate hymen • Transverse vaginal septum • Cervical agenesis Müllerian dysgenesis TX: •Psychological counselling • Creation of neo-vagina with dilation TX: Surgical Management

11. Secondary Amenorrhea

12. Top causes of 2° Amenorrhea Most common cause of Secondary Amenorrhea Pregnancy Physiologic amenorrhea in elderly women Menopause Lactation is a physiological state of hyperprolactinemia and associated amenorrhea. Breastfeeding 01 02 03

13. Other causes of 2° Amenorrhea •Primary Ovarian insufficiency •Thyroid Abnormalities

14. DIAGNOSIS OF 2° Amenorrhea • β- hCG Most important to rule out pregnancy TSH,PROLACTIN,FSH,LH,ANDROGENS, ESTRADIOL To assess for Estrogen status •Hormonal Work •Progesterone challenge • U/S To confrm normal anatomy, identify PCOS

15. Management ETIOLOGY MANAGEMENT Uterine defect • Asherman’s syndrome Evaluation with hysterosalpingography or sonohysterography HP-axis dysfunction Identify modifiable underlying cause • Combined OCP to decrease risk of osteoporosis, maintain normal vaginal and breast development Hyperprolactinemia MRI/CT head to rule out lesion • If no demonstrable lesions by MRI • Bromocriptine, cabergoline if fertility desired • Combined OCPs if no fertility desired • Demonstrable lesions by MRI: surgical management Polycystic Ovarian Syndrome •Cycle control •Treat infertility •Treat hirsutism

16. Prevention Healthy diet Menstrual cycle Regular tests Rest correctly Stay active Manage stress

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