Amenorrhea Causes and Treatment for USMLE Step 2
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- Опубликовано: 22 мар 2015
- Amenorrhea, a simple, handwritten explanation and full lecture of causes and treatment of amenorrhea for medical students taking USMLE. Discussing Amenorrhea signs and symptoms as well as treatment for amenorrhea.
Amenorrhea can be dividing into to categories. The first is primary amenorrhea and the other is second amenorrhea. In primary amenorrhea, the period has never occurred and the patient has no history of ovulation. However, in secondary amenorrhoea they did have a previous history of menses or period but now they are complaining that they are missing their period and ovulation, but now they haven't had it. In primary the definition is that they are 14 without sexual characteristics and 16 with secondary sexual characteristics. Definition of secondary amenorrhea is defined as 3 months of no menses if regular, and irregular would be 6 months of no menses.
Primary amenorrhea can be categorized based on the presence of other secondary characteristics such as ovulation. If there is no uterus, then it might be mulerian agenesis or androgen insensitivity. Mullerian Agenesis will be in a female (XX) and Androgen Insensitivity (XY). They will have normal breast growth and hair growth. Mullerian tubes is responsible for building of the upper vagina, cervix, uterus and the fallopian tube. Ovaries are unaffected so they will produce normal estrogen and the secondary characteristics will be normal and the FSH and LH levels will be normal. However the patient can't ovulate because there is no fallopian tube. This is treated by creating a vagina and IVF with a surrogate. Patient secretes androgens, however, receptors are deficient. Wollfian duct atrophys without testosterone, Mullerian Inhibiting Factor will not be activated and so the genitalia will be female. Patient will grow up as girls, secondary sexual characteristics however, they have an XY chromosome. They will have normal secondary sexual characteristics because testes will produce estrogen. This is treated by removing testes and estrogen.
Patients with no breast and primary amenorrhea means they are not producing any estrogen and therefore ovulation will not occur. Causes include Turner Syndrome (XO) and any problem with Hypothalamic Pituitary Axis (HPA). Streatk gonads means no gonads are produced and there will be an increase FSH. If problem with pituitary there is a lack of FSH and therefore no follicles are stimulated and then no estrogen is produced. Primary cause is Kallman syndrome (anosmia) or secondary causes such as anorexia, exercise, stress, craniopharyngioma. Treatment consists of giving exogenous estrogen and progesterone to develop the normal secondary characteristics.
If both uterus and breasts are present than the problem will be associated with anatomic problems. Vaginal Agenesis or septa and imperforate hymen. These patients are generally ovulating normally.
Secondary Amenorrhea is divided into three categories depending on gonadatropin level. In Eugonodatropin the level of LH and FSH is normal. The primary cause is pregnancy. Also anovulation can also lead to eugonadotropic where there will be no corpus luteum and therefore no progesterone. This can be due to PCOS, thyroid abnormalities, pituitary abnormalities, and anti-psychotic and anti-depressants.
Hypergonadtropic is due to low estrogen. Here it is due to premature ovarian failure. This can also be due to mumps, SLE, adrenal insufficiency, radiotherapy and even chemotherapy. In order to diagnosis you need to get 2 FSH levels 1 month apart to rule out early menopause.
if there is low T3/T4 which will increase TRH activates TSH and Prolactin which can go on to activate gonadotropin. Also check prolactin levels which can be raised due to anti-psychotics and anti-depressants. Tumors may also cause it so it requries CT Scan/MRI or it maybe an idiopathic increase in Prolactin. If everything is normal then a Progesterone Challenge Test (PCT) should be performed. Patient is given progesterone with single IM Dose or MPA for 7 days. After sudden stop there is bleeding than this means that the estrogen did prime the endometrium, but there was no ovulation for progesterone to come out and withdraw. So anovulation is the cause. Treat with clomiphene. If there is no bleeding then there is a problem with either estrogen or there is an outflow obstruction. If there is no bleeding then perform the Estrogen-Progesterone Challenge Test (EPCT). In this case patient receives 21 days of estrogen and followed with 7 days of Methylprogesterone acetate. If there is bleeding then there is no estrogen. If the FSH is high then there is ovarian failure, and if the FSH is low than there is an issue with hypothalamic pituitary axis. If there is no bleeding, the the problem is from obstruciton, endometrium or imperforate hymen.
I just want to add that the reason the testes are removed in androgen insensitivity is that they could become cancerous.
Incredibly helpful, thanks so much!
Helpful explanation of the progesterone challenge that I couldn't find anywhere else! Thanks! :)
Wonderful explanation. Makes it super easy to understand
I got confused when I read the book ,thanks a lot for making things more simple . 👏💃
Thank you for the great explanation!
Watching this 2020 so helpful thank you
Love this! Thank you.
Thanks it help me to understand amenorrhea
one of the best video i have ever seen.Thanks.
What the fuck is wrong with you. Have you never seen another video? This is the definition of dull and useless.
In androgen insensitivity, AMH is normally secreted and the female genitalia is developed due to absence of androgen effect not due to absence of AMH
superb!
Thank you
Amazing
Thanks man
thank you brother ...
gabrielalfa Your Welcome
Thanks ❤️❤️❤️❤️❤️❤️❤️❤️❤️
Sry sir i didn't understood some part
1. At 15:40 when u r talking about diagnosis, which diagnosis are u talking about, i mean to diagnose the patient with hypergonasotropin in general, or just the autoimmune cause of it?
2. "Diagnosis should be taking 2 FSH samples one month apart..." After that what u told was not clear
So, what are we gonna detect in those samples?
thank you so much T^T
Does Clegenatur Methods really work? I see a lot of people keep on talking about Clegenatur Methods. But I'm not sure if it is good enough to enhance their bust size naturally.
bro u forgot 5 alpha reductase deficiency...
According to Ayurveda, Amenorrhea is termed as ‘Anartava’. According to Acharya Charka, the imbalance of the Vata Dosha in women is the main cause of Amenorrhea. Aggravated Vata dosha accumulated in the body and relocated to Purishvaha srotas.
Thumbs up.....
Because you've never seen anything educational in your life before? this is horrible. What the fuck is wrong with you?
All my friends got there periods and are always relating and talking about it and im just like
._______________.
Thank you for your video, but your explanation of androgen insensitivity is not entirely correct. Testis develops in the XY fetus with AIS and secretes testosterone and MIF/AMH (Anti-Muller hormone). Due to AMH, the Mullerian ductus is unable to develop Fallopian tubes, uterus, cervix, and upper 1/3 of the vagina.
It's important to know that during early development, the gonads of the fetus remain undifferentiated (until the 7th/8th week). That is, all fetal genitalia are the same and are phenotypically female. Since in the 8th week testosterone can't affect genitalia, they remain like that.
There are different types of AIS, but in all of them, there is AMH that does what is written previously, the only difference is in the sensitivity of testosterone receptors.
Completely right
Does Clegenatur Methods really help to increase breast size naturally with natural ways? We have read many good things about this popular breast enhancement methods.
Wow, this is horrible
OMFG! He presumed everyone's gender!! He should be fired!!
I laughed because I'm hoping it's sarcasm but then again... it's 2019.
I never want to have children or sex so amenorrhoea is fine for me. If you don't want amenorrhoea pray to Jesus Christ and repent of your sins. "For as the body without the spirit is dead, so faith without works is dead." James 2:26
My friend faced an amenorrhea problem. She missed her menstrual periods. Due to which she suffered from great pain. Then she tried ayurvedic remedies offered by "Planet Ayurveda". These medicines were really very effective and now my friend has no problem with amenorrhea.