Download Amenorrhea

AMENORRHOEA
Menstruation
Is the endpoint of a cascade of events
which begins in the hypothalamus and
ends at the uterus
DEFINITION
Complete absence of menstrual
bleeding.
CLASSIFICATION
A.
Cryptomenorrhoea (False)
B. True Amenorrhoea
• Physiological
•
Pathological
Primary
Secondary
Primary:
No spontaneous onset of
menstruation by the age of
16 years.
Secondary:
Absence of menstruation
for 6 months or longer if
the patient has previously
experienced regular menses.
CRYPTOMENORRHOEA
Regular shedding of endometrium,but there is
mechanical obstruction.
CAUSES
Vagina
1 Imperforate Hymen
2 Non canalisation or absence of vagina
Cervix
1. Congenital
2. Acquired

Infection
Trauma
Surgery
CRYPTOMENORRHOEA
Signs
1. Amenorrhea
2. Pain
3. Retention of urine
Signs
1. Secondary sexual characters are present
2. Dark bluish membrane (imperforate hymen)
3. Pelvic mass
Treatment
1.Hymenectomy
2.Vaginoplasty
3.Cervical dilatation.
Physiological Amenorrhea
Prepuberty:
– Due to low production of gonadotrophic hormones
Pregnancy:
– Increased amounts of oestrogens & progesterone by
placenta
Lactation:
Increased levels of prolactin
Menopause:
ovaries unresponsive to stimulus of gonadotrophins
Constitutional delay:
Familial
PATHOLOGICAL
Causes:
Uterus
Ovary
Anterior pituitary
Hypothalamus
Others
Causes of Amenorrhea
Uterus
Absence of Uterus
I.Congenital
II.Surgical
Diseases of Endometrium
I.T.B
II.Destruction of Endometrium
Irradiation
Asherman’s Syndrome
Causes of Amenorrhea
Ovaries
Absent or Streak Ovaries
Chromosomal Anomalies
I. Turner (XO)
II. Trisomy (XXX)
III.Gonadal Dysgenesis
IV.Androgen insensitivity Syndrome
Bilateral Oophorectomy
Irradiation
Abnormal production of Hormone – PCOD
Causes of Amenorrhea

Neoplasms
–
Hormone Producing Tumours
–
Oestrogen Producing
I. Granulosa Cell
II. Theca Cell
Androgens Producing Tumours
I. Arrhenoblastoma
Anterior Pituitary
•
Congenital Defect
Empty Sella Syndrome
•
Ischemia Damage
Sheehan Syndrome
•
Neoplasms
Craniopharyngioma
•
Hypophysectomy
Hypothalamus

Psychological
•
•
•
•
Excitement, Depression, Anxiety
Change of environment, climate, job
Anorexia nervosa
Pseudocyesis
Hypothalamus

Neurological
•
•
•
•
Inflammatory
Traumatic – Fracture of skull
Neoplasms
Drugs
Other Causes

Endocrinal Diseases
•
•
•

Thyroid gland
Adrenal cortex
Diabetes Mellitus
Acute or Chronic Illness
•
•
•
T.B
Malignant diseases
Renal failure
Other Causes
•
•
•
Changes In Weight
Exogenous Hormones
Excessive exercise
MANAGEMENT

History of the patient.
 General physical examination.
 Pelvic Examination.
 Investigations.
INVESTIGATIONS
Blood
• Complete picture,BGR.
Urine Analysis
Ultrasonography
Radiological
• X-ray of the skull and Chest
• Intravenous Urography
• CT scan/MRI
Hormone Assay
•
•
•
•
•
•
FSH
LH
Prolactin
Testosterone
SHBG
Thyroid Tests
Endometrial Biopsy
Buccal Smear
Karyotyping
Laparoscopy,Hysteroscopy
Therapeutic Test
TREATMENT
General Measures.
Reassurance and psychotherapy.
Nutrition.
Weight Control.
END OF LESSON