{"id":184,"date":"2020-08-13T16:06:03","date_gmt":"2020-08-13T16:06:03","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=184"},"modified":"2021-05-09T20:49:14","modified_gmt":"2021-05-09T20:49:14","slug":"43-amenorrhea","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/43-amenorrhea\/","title":{"rendered":"43. Amenorrhea"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/pr6YRAH8nTU\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 5:44<\/p>\n<input type='hidden' bg_collapse_expand='69e9b56c3e7e48069772525' value='69e9b56c3e7e48069772525'><input type='hidden' id='bg-show-more-text-69e9b56c3e7e48069772525' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b56c3e7e48069772525' value='Hide Transcript'><button id='bg-showmore-action-69e9b56c3e7e48069772525' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b56c3e7e48069772525' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 43<br \/>\n00:02<br \/>\namenorrhea amenorrhea is the absence of<br \/>\n00:05<br \/>\nmenstruation and can be classified as<br \/>\n00:07<br \/>\nprimary or secondary a young woman with<br \/>\n00:10<br \/>\nprimary amenorrhea has never menstruated<br \/>\n00:12<br \/>\nif she has never menstruated by age 13<br \/>\n00:16<br \/>\nand has no secondary sexual development<br \/>\n00:18<br \/>\nthan she was classified as having<br \/>\n00:19<br \/>\nprimary amenorrhea alternatively by age<br \/>\n00:22<br \/>\n15 if she has never menstruated and has<br \/>\n00:25<br \/>\nsecondary sexual development than she is<br \/>\n00:26<br \/>\nalso classified as having primary<br \/>\n00:28<br \/>\namenorrhea secondary amenorrhea is<br \/>\n00:31<br \/>\ndiagnosed when a menstruating woman has<br \/>\n00:33<br \/>\nnot menstruated for 3 to 6 months or has<br \/>\n00:35<br \/>\nmissed 3 periods these terms should not<br \/>\n00:38<br \/>\nbe confused with all ago materia which<br \/>\n00:40<br \/>\nis the reduction of the frequency of<br \/>\n00:41<br \/>\nmenses with bleeding 3 days greater than<br \/>\n00:44<br \/>\n40 but less than 6 months the objectives<br \/>\n00:47<br \/>\nof this video to explain the<br \/>\n00:48<br \/>\npathophysiology and identify ideologies<br \/>\n00:50<br \/>\nof amenorrhea and ala komen area<br \/>\n00:52<br \/>\nincluding possible nutritional causes<br \/>\n00:54<br \/>\ndescribe associated symptoms examination<br \/>\n00:57<br \/>\nfindings diagnostic tests and management<br \/>\n00:59<br \/>\nof amenorrhea discuss the consequences<br \/>\n01:02<br \/>\nof untreated amenorrhea and algal<br \/>\n01:04<br \/>\nmalaria the most common cause of<br \/>\n01:06<br \/>\namenorrhea is pregnancy and this should<br \/>\n01:08<br \/>\nalways be ruled out prior to further<br \/>\n01:10<br \/>\nevaluation of amenorrhea the three most<br \/>\n01:12<br \/>\ncommon causes of amenorrhea not from<br \/>\n01:14<br \/>\npregnancy are hypothalamic pituitary<br \/>\n01:16<br \/>\ndysfunction ovarian dysfunction and<br \/>\n01:18<br \/>\nanatomic abnormalities let&#8217;s start our<br \/>\n01:21<br \/>\ndiscussion of hypothalamic pituitary<br \/>\n01:23<br \/>\ndysfunction with a quick tutorial about<br \/>\n01:25<br \/>\nthe hpo axis the hypothalamus releases<br \/>\n01:28<br \/>\nGnRH in a pulsatile fashion and this<br \/>\n01:30<br \/>\ntravels to the anterior pituitary in the<br \/>\n01:32<br \/>\npituitary stalk this GnRH stimulates the<br \/>\n01:36<br \/>\nanterior pituitary to release FSH and LH<br \/>\n01:38<br \/>\nthe FSH and LH stimulate the ovaries to<br \/>\n01:42<br \/>\nbegin the cycle of folliculogenesis<br \/>\n01:43<br \/>\novulation and estrogen and progesterone<br \/>\n01:46<br \/>\nrelease anything that alters is delicate<br \/>\n01:49<br \/>\nfeedback loop can cause hypothalamic<br \/>\n01:51<br \/>\npituitary amenorrhea April acting<br \/>\n01:54<br \/>\nsecreting pituitary adenomas or<br \/>\n01:56<br \/>\ncraniopharyngioma can impinge on the<br \/>\n01:58<br \/>\npituitary stalk and alter blood flow<br \/>\n02:00<br \/>\nmore common functional causes include<br \/>\n02:03<br \/>\nweight loss excessive exercise or<br \/>\n02:06<br \/>\nobesity modifying the causal behavior<br \/>\n02:08<br \/>\ncan often restore menses the female<br \/>\n02:11<br \/>\nathlete triad of amenorrhea dis or<br \/>\n02:13<br \/>\neating and osteopenia or osteoporosis<br \/>\n02:15<br \/>\ndemonstrates the need for sufficient<br \/>\n02:17<br \/>\ncaloric intake to enable the energy<br \/>\n02:19<br \/>\nexpenditure for the hpo access to<br \/>\n02:21<br \/>\nfunction other potential causes for HP o<br \/>\n02:24<br \/>\namenorrhea include head injury marijuana<br \/>\n02:26<br \/>\npsychoactive drugs chronic anxiety<br \/>\n02:29<br \/>\nanorexia nervosa and chronic medical<br \/>\n02:31<br \/>\nillness now we will discuss another<br \/>\n02:34<br \/>\ncause of amenorrhea ovarian failure<br \/>\n02:36<br \/>\novarian failure occurs when the ovaries<br \/>\n02:39<br \/>\nare exhausted or are resistant to FSH<br \/>\n02:41<br \/>\nand LH the most common causes of ovarian<br \/>\n02:44<br \/>\nfailure are chromosomal abnormalities<br \/>\n02:46<br \/>\nsuch as Turner&#8217;s syndrome which lead to<br \/>\n02:48<br \/>\na variant is genesis or autoimmune<br \/>\n02:50<br \/>\novarian failure anatomic abnormalities<br \/>\n02:54<br \/>\ncausing amenorrhea can be congenital or<br \/>\n02:56<br \/>\nacquired common congenital causes<br \/>\n02:59<br \/>\ninclude imperforate hymen or absence of<br \/>\n03:02<br \/>\nthe uterus or vagina a Sherman syndrome<br \/>\n03:05<br \/>\nis the most common cause of secondary<br \/>\n03:06<br \/>\namenorrhea<br \/>\n03:07<br \/>\nthis can occur after dilation and<br \/>\n03:09<br \/>\ncurettage especially for retain products<br \/>\n03:11<br \/>\nof conception in the setting of<br \/>\n03:12<br \/>\ninfection this causes scarring of the<br \/>\n03:14<br \/>\nendometrium the first step of treatment<br \/>\n03:17<br \/>\nis to establish the cause of amenorrhea<br \/>\n03:19<br \/>\nmany physicians use the progesterone<br \/>\n03:22<br \/>\nchallenge test as the first step a<br \/>\n03:24<br \/>\npatient takes oral progesterone for ten<br \/>\n03:26<br \/>\ndays after stopping the progesterone if<br \/>\n03:29<br \/>\nshe then has bleeding we refer to this<br \/>\n03:31<br \/>\nas a withdraw bleed for she&#8217;s<br \/>\n03:33<br \/>\nessentially withdrawing from the<br \/>\n03:34<br \/>\nprogesterone therapy this tells us that<br \/>\n03:37<br \/>\nshe has adequate estrogen a competent<br \/>\n03:39<br \/>\nendometrium and a Paton outflow tract if<br \/>\n03:42<br \/>\nbleeding occurs then further workup<br \/>\n03:44<br \/>\nshould investigate causes like thyroid<br \/>\n03:46<br \/>\ndisease hyperprolactinemia polycystic<br \/>\n03:49<br \/>\novarian syndrome and congenital adrenal<br \/>\n03:51<br \/>\nhyperplasia<br \/>\n03:52<br \/>\nif withdrawal bleeding does not occur<br \/>\n03:54<br \/>\nthan a combined estrogen and<br \/>\n03:56<br \/>\nprogesterone test can be performed to<br \/>\n03:58<br \/>\ndifferentiate an outflow tract<br \/>\n03:59<br \/>\nabnormality from inadequate estrogen<br \/>\n04:01<br \/>\nlevels in this test estrogen is given<br \/>\n04:04<br \/>\nfor 21 days then progesterone is given<br \/>\n04:06<br \/>\nfor 7 to 10 days and the patient is<br \/>\n04:08<br \/>\nagain evaluated for withdrawal bleed if<br \/>\n04:11<br \/>\nno bleeding occurs after this test that<br \/>\n04:13<br \/>\nan ultrasound or MRI should be performed<br \/>\n04:16<br \/>\nto look for anatomic abnormalities if<br \/>\n04:18<br \/>\nbleeding occurs after the test FSH<br \/>\n04:21<br \/>\nlevels should be checked a high serum<br \/>\n04:23<br \/>\nFSH is indicative of primary ovarian<br \/>\n04:25<br \/>\ninsufficiency<br \/>\n04:27<br \/>\na karyotype should then be performed to<br \/>\n04:28<br \/>\nassess for complete or partial deletion<br \/>\n04:30<br \/>\nof the X chromosome as in Turner<br \/>\n04:32<br \/>\nsyndrome treatment of amenorrhea depends<br \/>\n04:35<br \/>\non the etiology anatomic abnormalities<br \/>\n04:37<br \/>\nsuch as imperforate hymen can be<br \/>\n04:39<br \/>\nsurgically corrected which will allow<br \/>\n04:40<br \/>\nfor menstruation and fertility a Sherman<br \/>\n04:42<br \/>\nsyndrome can be treated with license of<br \/>\n04:44<br \/>\nadhesions and post-operative estrogen<br \/>\n04:46<br \/>\ntherapy women with ovarian failure<br \/>\n04:48<br \/>\nshould receive hormone therapy to avoid<br \/>\n04:50<br \/>\nthe negative side effects of estrogen<br \/>\n04:52<br \/>\ndeficiency especially for bone and heart<br \/>\n04:54<br \/>\nhealth hypothalamic pituitary<br \/>\n04:57<br \/>\ndysfunction can be improved by<br \/>\n04:59<br \/>\ncorrecting the functional cause of the<br \/>\n05:00<br \/>\ndisruption the consequences of untreated<br \/>\n05:03<br \/>\namenorrhea depend also on the underlying<br \/>\n05:05<br \/>\netiology for women with the athletes<br \/>\n05:08<br \/>\ntrier there are many issues that may<br \/>\n05:09<br \/>\nneed to be addressed including<br \/>\n05:10<br \/>\ndisordered eating patterns body image<br \/>\n05:13<br \/>\nissues and bone health this may involve<br \/>\n05:15<br \/>\na multidisciplinary team with cognitive<br \/>\n05:17<br \/>\nbehavioral therapy the consequences for<br \/>\n05:20<br \/>\nthese women can involve long term<br \/>\n05:22<br \/>\ncardiovascular and osteoporosis risk<br \/>\n05:24<br \/>\nfrom years of low estrogen exposure this<br \/>\n05:26<br \/>\nconcludes the aapko educational video on<br \/>\n05:28<br \/>\namenorrhea we have discussed many of the<br \/>\n05:30<br \/>\ncauses evaluation and treatment options<br \/>\n05:33<br \/>\nfor this condition in women<\/p>\n<p><\/div>\n<hr \/>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 5:44<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":43,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-184","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/184","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=184"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/184\/revisions"}],"predecessor-version":[{"id":2848,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/184\/revisions\/2848"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}