Amenorrhea  Anovulation

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Amenorrhea. Transient, intermittent, or permanentResults from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina . 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

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Amenorrhea Anovulation

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1. Amenorrhea & Anovulation Andrea Chymiy, MD Swedish Family Medicine

2. Amenorrhea Transient, intermittent, or permanent Results from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina

3. 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

4. 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%

5. 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)

6. 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?)

7. Physical Exam: Evaluation of pubertal development - including height, weight, & Tanner staging. Pelvic exam to check for presence of cervix, uterus, ovaries (may need ultrasound) Check skin for signs of androgen excess (acanthosis nigras, hirsutism, acne, & striae) and vitiligo (thyroid disorders) Check for physical features of Turner syndrome (low hair line, web neck, shield chest, and widely spaced nipples)

8. Tanner staging

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