Women's Health – Gynecology Summary Questions with Answers for final Examination

What is amenorrhea? - ***absence of menstruation Workup for amenorrhea - ***pregnancy test, serum prolactin, FSH, LH, TSH What is primary amenorrhea? - ***Failure of onset of men arch by age 13y (with absence of 2/2 sex characteristics) or age 15y (with 2/2 sex characteristics) What causes + breast/+uterus in primary amenorrhea? - ***Outflow obstruction: 1. transverse vaginal septum 2. imperforate hymen What causes +breast/-uterus in primary amenorrhea? - ***1. Mullerian agenesis (46XX) 2. androgen insensitivity (46XY) What causes -breast/+uterus in primary amenorrhea? - ***1. Elevated FSH/LH = ovarian causes - POF, gonadal dysgenesis 2. Normal/Low FSH, LH = hypothalamus-pituitary failure, puberty delay What causes -breast/-uterus in primary amenorrhea? - ***Defect in testosterone synthesis. Presentation: immature girl with primary amenorrhea (intrabdominal testes) Genetic disorder which causes primary amenorrhea - ***Turner's syndrome Turner's Syndrome (XO) - ***- female w/ absent or nonfunctional sex chromosome - fibroid ovaries - menopause before menarche - Appearance: short, webbed neck, low hairline, low set ears, widely spaced nipples secondary amenorrhea - ***no menses for 3 months in a patient with previously normal menstruation (or 9 mo. in pt. previously oligomenorrheic) Etiologies of secondary amenorrhea - ***1. Pregnancy 2. H-P dysfunction 3. Pituitary dysfunction 4. Ovarian d/o 5. Uterine d/o What is the MC cause of secondary amenorrhea? - ***pregnancy Causes of H-P dysfunction in secondary amenorrhea - ***1. anorexia (weight loss 10% below IBW) 2. exercise, stress 3. nutritional deficiencies 4. systemic dz (Celiac) Lab presentation of H-P dysfunction in amenorrhea - ***Normal - Low FSH/LH low estradiol normal prolactin Management of H-P dysfunction in secondary amenorrhea - ***Stimulate gonadotropin secretion: Clomiphene Menotropin (Pergonal) What causes pituitary dysfunction resulting in secondary amenorrhea? - ***prolactin secreting pituitary adenom