2. Definition OfDefinition Of AmenorrheaAmenorrhea
â˘Is complete absence ofIs complete absence of
menstruation in themenstruation in the
childbearing period.childbearing period.
4. Background
⢠Understanding normal menstruation.
⢠Classification of amenorrhea.
⢠Amenorrhea is a Symptom not a disease, so
the final diagnosis should be pathological .
5. Pre-requisities for normality of menstruation
⢠Coordinated Neuro endocrine Axis.Coordinated Neuro endocrine Axis.
⢠Responsive ,patent Utero vaginal canalResponsive ,patent Utero vaginal canal..
⢠Good general health .Good general health .
7. Classifications Of AmenorrheaClassifications Of Amenorrhea
⢠According to the onset:According to the onset:
â Primary amenorrhea.Primary amenorrhea.
â Secondary amenorrhea.Secondary amenorrhea.
⢠According to the cause:According to the cause:
â Physiological.Physiological.
â PathologicalPathological
⢠According to Hidden or apparantAccording to Hidden or apparant::
â False amenorrheaFalse amenorrhea ((Crypto menorrheaCrypto menorrhea).).
â True amenorrhea.True amenorrhea.
⢠These are complementary to each otherThese are complementary to each other
15. Crypto menorrhea
- Intermittent abdominal pain
- Possible difficulty with micturition
- Possible lower abdominal swelling
- Bulging bluish membrane at the
introitus or absent vagina (only
dimple)
32. Craniopharyngioma
⢠Arises from remnants ofArises from remnants of Rathke'sRathke's pouchpouch
⢠Compresses the hypothalamusCompresses the hypothalamus
⢠SuppressSuppress GnRHGnRH secretion .secretion .
⢠Interrupt portal flow ofInterrupt portal flow of GnRHGnRH in the pituitary stalk.in the pituitary stalk.
⢠Calcifications may be apparent on radiography ofCalcifications may be apparent on radiography of
thethe sella turcica.sella turcica.
⢠Frequent manifestations includeFrequent manifestations include visual field defectsvisual field defects
and blurring visionand blurring vision..
33. GalactorrhoeaGalactorrhoea ++ amenorrhea.amenorrhea.
⢠Chiari-Frommel syndrome
âIt occursIt occurs after deliveryafter delivery: due to: due to
persistentpersistent ProlactinProlactin secretion.secretion.
⢠Delcastello syndrome:
â˘It is not preceded by delivery.It is not preceded by delivery.
35. Sheehan's syndrome &Simmonds
⢠Postpartum hge.Postpartum hge.
⢠Failure of gonadotrphic function +Failure of gonadotrphic function + failure offailure of
lactationlactation..
⢠More extensive damage lead to :More extensive damage lead to :
⢠Simmonds :Simmonds : (Destruction of the anterior pituitary gland(Destruction of the anterior pituitary gland
due todue to septic emboliseptic emboli due todue to puerperal sepsispuerperal sepsis.).)
36. Pituitary Adenoma
⢠Evaluation of theEvaluation of the sella turcicasella turcica withwith (MRI)(MRI) ++ radiographyradiography isis
necessary.necessary.
⢠Vary in size.Vary in size.
⢠Micro adenomasMicro adenomas (less than 10 mm).(less than 10 mm).
⢠Macro adenomasMacro adenomas (more than 10 mm).(more than 10 mm).
⢠May beMay be associatedassociated with:with:
â Visual changes.Visual changes.
â Galactorrhoea.Galactorrhoea.
â Hypothyroidism.Hypothyroidism.
â AmenorrheaAmenorrhea
37. Work up for : hypothalamic- pituitary
⢠History
⢠Exam
⢠InvestigationâŚ
⢠Then:
⢠Categorize as primary or secondary
⢠Categorize causeâŚâŚ..
38. History in primary amenorrhea
⢠Developmental milestones (age of growth
spurt ,age of thelarche, adrenarche)
⢠Chronic illness (CRI ,TB, Bl disease).
⢠Weight changes
⢠Excessive exercise
⢠History of anosmia
49. General Principles of management
⢠Try causative Treatment.
⢠Do not forget general factors
⢠Remember stress is common cause in
adolescents
⢠Pregnancy is the commonest cause of
secondary amenorrhea
50. General Principles of management
. HRT: (estrogen and progesterone)
In hypo-estrogenic amenorrheic women (to prevent
osteoporosis)
. Periodic progestogen:
In euestrogenic amenorrheic women (to avoid endometrial cancer)
. If Y chromosome is present: gonadectomy is indicated
. Many cases require frequent re-evaluation