Amenorrhea

The Amenorrhea, part of the OBGYN section provides High Yield information for the USMLE Step 1,2,3, COMLEX Level 1,2,3, Residency, and as a practicing Physician.

Primary Amenorrhea

Secondary sex characteristics and Menstruation

• Age:
  • 13: secondary sex characteristics
    
  • 15: menstruation
    
  • If not at these times THEN do a work up

Breast +, but – Uterus

• DDX:
  
  • 1. Mullerian agenesis (XX)
    
  • 2. androgen insensitivity (XY)
    
• Dx:
  • testosterone levels and karyotype

No breast, but + uterus development

• DDX:
  
  • 1. Craniopharyngioma (“no” Ant, pit = no FSH/LH)
    
  • 2. Kallman’s- hypothalamus defect ( no GnRH)
    
  • 3. Turner’s high FSH and LH (ovarian failure)

Kallman’s syndrome

• Presentation:
  • Primary amennorhea low FSH and LH and ansomia

Turner Syndrome

• Presentation:
  • 1. streak ovaries
    2. Intact primary sex characteristics and mullerian structures
    3. Broad chest, webbed neck
    4. Cardiac abnormalities (coarctation, bicuspid aorta)

Secondary Amenorrhea

• 3 most common causes:
  • 1. Pregnancy
    
  • 2. Thyroid
    
  • 3. Prolactin
• Most common way thyroid disease causes secondary amenorrhea:
  • 1. Hypothyroid leading to increased TRH leading to increased prolactin which inhibits GnRH
    
  • 2. Get TSH- if High then give levo
• Role of dopamine on prolactin:
  • dopamine blocks prolactin, thus atypical antipsychotics can cause galactorrhea by DISINHIBITING prolactin by blocking dopamine
• Dx algorithym:
  • Start at uterus and work up:
    
  • 1. Progesterone test
    
  • 2. Estrogen and progesterone test
    
  • 3. FSH/LH
    
  • 4. MRI

Menopause

• Labs:
  • Increased FSH and LH
    
  • NO follicles on US

Prolactinoma

• Treatment:
  • First line
    • 1. Pramipaxole
      
    • 2. Ropinerole
      
    • These dopamine agonists will block prolactin release.

Savage Syndrome

• Presentation:
  • Failure of the ovaries to respond to FSH and LH due to a receptor defect – primary ovarian failure