BIO 116 OBGYN Study Guide

Amenorrhea (See Prof. Brown’s notes) a. Primary Amenorrhea i. Failure of menarche onset by age 15 years (in the presence of secondary sex characteristics) or age 13 years (in the absence of secondary sex characteristics) ii. Workup: 1. hCG & FSH = most important! 2. TSH & prolactin also usually ordered initially 3. Karyotype testing done if increased FSH & little breast development b. Secondary Amenorrhea i. Absence of menses for 3 months in a pt with previously normal menstruation ii. Etiologies: 1. Pregnancy = MC cause! 2. Hypothalamic Dysfunction – Functional Hypothalamic Amenorrhea (FHA) a. Puberty delay (s/a in athletes, illness or anorexia) b. Female athlete triad: hypothalamic amenorrhea, eating disorder & OP (d/t loss of bone production by estrogen) c. FHA can cause primary or secondary amenorrhea! 3. Pituitary Dysfunction – prolactinoma or pituitary infarct (Sheehan syndrome) a. Assoc. with decreased FSH, LH & estrogen 4. Ovarian Dysfunction – PCOS, Turner Syndrome, Premature Ovarian Failure (follicular failure or follicular resistance to FSH/LH) a. Decreased estrogen & increased FSH & LH b. May have sx of estrogen deficiency (similar to menopause) 5. Uterine dysfunction: Asherman’s syndrome a. Acquired endometrial scarring secondary to postpartum hemorrhage, after D&C or endometrial infection b. Pelvic US  absence of normal uterine stripe