Primary Amenorrhea: Causes & Menstrual Cycles – Gynecology | Lecturio


[Music] hello I would like to discuss primary and secondary amenorrhea with you this is often tested on the USMLE so pay close attention let’s review what a normal menstrual cycle is like it’s between 21 and 35 days there is another lecture about AUB if you’d like to find out more I’d like to discuss the terminology that we use all ago malaria means periods that are greater than every 35 days apart it can also mean less than 9 mental cycles per year poly materia is different it actually means that your periods come too frequently they are less than 21 days in the interventional bleeding menorrhagia means you have too much flow greater than 80 milliliters and seven days Metro Rajah means that you have a regular bleeding between vincey’s and amenorrhea means no menses that can be either primary or secondary and we’ll find out more in just a second remember if you’d like to know the new terminology please refer to the AUV lecture so this is an overview of the hypothalamic pituitary axis now depending on what the target organ is there are different hormones that come from the pituitary as you see here there are different hormones organ editor opens or trophic hormones that come from the anterior pituitary and the posterior pituitary and they have different effects on the target organ all of these systems may have a role in normal menstrual solicit II you can see here the target and organ hormone production is definitely influenced by the anterior pituitary and the hypothalamus let’s review primary amenorrhea in primary amenorrhea you have never had a menstrual cycle this is pathologic if you are aged thirteen and has no secondary sexual characteristics to remind you breasts axillary and pubic hair are all secondary sexual characteristics by age 15 even if you have secondary sexual characteristics if you have no menses this is pathologic again it’s very important to remember that the hpo axis must be intact for a young woman to have a menstrual cycle if she has a materia something has gone wrong at the level of the hpo axis it could be the environment that is feeding back information into the CNS the CNS then obviously corresponds to the hypothalamus the hypothalamus has to release genetic open releasing hormone to the anterior pituitary the anterior pituitary will release Gananoque opens SSH follicle stimulating hormone and luteinizing hormone or LH to the ovary the ovaries in produces estrogen and progesterone the uterus is influenced by estrogen and progesterone and the withdrawal of both of those hormones result in a menstrual cycle let’s now go over with common causes that we see in primary aim in areia if you have a patient that has breast development you consider that their cause of primary aim in area may be mullerian a Genesis there is a separate talk on mullerian a Genesis or variants in another lecture if you’d like more information also androgen insensitivity can also present as primary aim in area there is another lecture set where you can learn more about complete and partial androgen insensitivity also women may have anatomic factors that actually prevent menses one of those is a vaginal septum they may also have an imperforate hymen or they may overall have constitutional delay if you have no breast development likely you will have a high SSH or follicle stimulating hormone this can happen in normal genetic females such as 46 X X it can also happen in 46 XY individuals let’s also now talk about low FSH you can typically have a low FSH with constitutional a this also happens with prolactin Oma’s and calman syndrome you may get tested without common salt syndrome so I will spend a little time here these patients usually have a nas mia which means they cannot smell they usually have primary amenorrhea and will need assistance to become pregnant should they like to become pregnant in the future other CNS pathology can also lead to a low FSH stress weight loss and anorexia is typical to have a low s SH associated with it polycystic ovarian syndrome can also have a normal to low SSH and again congenital adrenal hyperplasia may have a low FSH as well if you’d like to learn more about CAH or continual adrenal hyperplasia there is a separate lecture set for that I want to bring your attention to a really quick mnemonic to remember the causes of primary aim in areia when I was a medical student it was difficult for me to remember but I’m going to give you a quick tip on how you can remember it remember xmas x is for 45 X 0 or Manas only associated with Turner syndrome M is for mullerian agenesis recall that there is another lecture about malaria Genesis that you can review a is for androgen insensitivity syndrome this is typical with complete androgen insensitivity syndrome again you can review this in another lecture set lastly S is for Swire syndrome this is also referred to as XY gonadal dis Genesis [Music]

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