1 / 25

Amenorrhea (and Dysfunctional Uterine Bleeding)

Amenorrhea (and Dysfunctional Uterine Bleeding). Dr. ELHAM GHANBARI JOLFAEI OB&MD Gynecologiest. Amenorrhea: “absence of menses”. “Normal cycle is 28 days This occurs in 15% of cycles 98% have cycles between 24-35 days Average duration 4-6 days (2-8 normal)

amajor
Download Presentation

Amenorrhea (and Dysfunctional Uterine Bleeding)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Amenorrhea (and Dysfunctional Uterine Bleeding) Dr. ELHAM GHANBARI JOLFAEI OB&MD Gynecologiest

  2. Amenorrhea: “absence of menses” • “Normal cycle is 28 days • This occurs in 15% of cycles • 98% have cycles between 24-35 days • Average duration 4-6 days (2-8 normal) • Average blood loss per cycle = 30 ml. • > 80 ml. Leads to risk for anemia

  3. PRIMARY AMENORRHEA • Patient has never menstruated • No period by age 14 with no secondary sexual characteristics • No period by age 16 regardless of secondary sexual characteristics

  4. SECONDARY AMENORRHEA • Previously established cycles cease

  5. ALWAYS RULE OUT PREGNANCY Then evaluate the four parts of the system

  6. REASONS FOR AMENORRHEA • Pregnancy • Menopause • Thyroid/Prolactin Disorders • Anovulation • Outflow obstruction • CNS/hypothalamic dysfunction • Drugs/Stress/Nutrition • Chromosomal/Abnormal Sexual Differentiation

  7. ALWAYS RULE OUT PREGNANCY!!!!!!! No matter WHAT!!!

  8. STEP ONE – will diagnose pregnancy, thyroid disorder, hypoprolactinemia and anovulation • LABS • Beta hcg • TSH • Prolactin • MEDS • Progestin challenge • {If galactorrhea, obtain MRI of pituitary/sella turcica}

  9. STEP TWO – will diagnose outflow tract obstruction • Give estrogen “priming”, followed by progestin • Estrogen x 21 days • Add progesterone for the last 5 days

  10. STEP 3- will determine if lack of estrogen is due to ovarian failure vs. altered CNS/pituitary axis • FSH • (LH)

  11. I. UTERUS – VAGINA – OUTFLOW TRACT • Asherman’s – secondary amenorrhea • Imperforate hymen – primary amenorrhea • Vaginal septum – primary amenorrhea • Agenesis – primary amenorrhea • Testicular feminization – primary amenorrhea

  12. II. OVARY • Chromosomes Normal- • Menopause • Radiation/Chemo • Autoimmune Disorder • Infection • Chromosomes Abnormal- • Primary Amenorrhea • Premature Menopause

  13. III. ANTERIOR PITUITARY • Prolactin Secreting Tumors • Sheehan’s Syndrome

  14. IV. CNS / HYPOTHALAMUS • Weight loss, anorexia, stress, intense exercise • Hypothyroidism – TRH/drugs which affect dopamine • Anovulation • Hypothalamic Suppression

  15. ALWAYS, ALWAYS, ALWAYS • RULE OUT PREGNANCY

  16. CASE STUDY • 17 year old female with primary amenorrhea. She is of normal weight and has mature secondary sexual characteristics.

  17. CASE STUDY • 15 year old with three months of secondary amenorrhea. She underwent normal pubertal development and had menarche at age 12 with regular cycles for three years. She is on the track team.

  18. CASE STUDY • 42 year old G3P3 with 5 months amenorrhea. Normal weight. Has been experiencing hot flashes.

  19. CASE STUDY • 28 year old G2P2 with 8 months of amenorrhea. Has been gaining weight lately, feels cold all of the time, and complains of constipation and fatigue.

  20. CASE STUDY • 35 year old G0 with amenorrhea for 9 months. Overweight. Slightly hirsute.

More Related