AmenorrheaDanielle, Kelsey, Joe, MattTable 3 Period 3

An Overview

An Overview

• Amenorrhea is defined as the absence of menstrual bleeding and may be primary or secondary.

An Overview

• Primary Amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics in a girl by age 14.

-OR-• The absence of menstrual bleeding with

normal development of secondary sexual characteristics in a girl by age 16.

An overview

• For a woman to have a regular menstrual cycle, her HYPOTHALAMUS, PITUITARY gland, OVARIES and UTERUS should all be functioning normally.

An overview

• The Hypothalamus stimulates the pituitary gland by releasing follicle stimulating hormones (FSH) and luteinizing hormone (LH).

• This causes the ovaries to produce the hormones estrogen and progesterone.

An overview

• Estrogen and progesterone are responsible for the cyclical changes in the endometrium ( uterine lining), including menstruation.

A chart illustrating a normal menstrual cycle.

Causes

Hypothalamic causes

• Craniopharyngioma- a brain tumor near the pituitary gland.

• Teratoma-a tumor made up of a mixture of tissues.

• Sarcoidosis- the formation of nodules in different parts of the body.

Hypothalamic causes

• Kallmann Syndrome- Deficiency of gonadotropins, which are hormones capable of promoting growth and function of reproductive hormones.

• Nutritional Deficiency • Low Body Weight

Pituitary Causes

• Prolactinemia- High blood levels of prolactin, a hormone that stimulate the secretion of breast milk.

• Pituitary Tumors• Postpartum Pituitary Necrosis- Death of

pituitary cells after a woman delivers a baby.

Pituitary causes

• Autoimmune Hypophysitis- Cells of the pituitary gland destroyed by the body’s own defense system

• Pituitary Radiation

Ovarian Causes

• Anovulation- Lack of the release of an egg• Hyperandrogenemia- High blood levels of

male hormones• Polycystic ovary syndrome• Premature Ovarian Failure• Turner Syndrome-Genetic disorder

characterized by underdeveloped ovaries, short stature.

Ovarian Causes

• Pure Gonadal Dysgenesis- Defective development of the ovary

• Autoimune Oophoritis- Cells of the ovaries destroyed by the body’s own defense system

• Radiation or Chemotherapy• Abnormalities of the genital tract

Functional Causes

• Anorexia/Bulimia• Chronic Disease ( Ex: Tuberculosis)• Excessive weight gain/loss• Malnutrition • Psychiatric Disorders• Recreational Drug Abuse• Excessive Stress• Excessive Exercise

Symptoms

Symptoms

• Amenorrhea is a symptom of an underlying disorder.

Symptoms

• Galactorrhea- Production of breast milk in women who are not pregnant

• Headache• Reduced Peripheral Vision

These could be signs of an intracranial tumor.

Symptoms

• Noticeable weight gain/ loss• Excessive anxiety• Hot Flashes• Night Sweats• Disrupted Sleep

These can be signs of Ovarian Insufficiency or Premature Ovarian Failure.

Exams and Tests

Exams and Tests

• Blood Tests to determine hormone levels• CT or MRI of the head to exclude pituitary and

hypothalamic causes• Thyroid Function Tests• Hysteroscopy-Visual inspection of uterus

Medical Treatments

Medical Treatment

• Hormone Replacement Therapy• Radiation Therapy for tumor-related• Contraceptives to restore menstrual cycle

Sources

Amenorrhea. (2002). In Britanica (15th ed., Vol. 1, p. 324). Chicago: Encyclopedia Britanica Inc. (Original work published 1768)

Slap, G., M.D. (2005). Amenorrhea. In K. Krapp & J. Wilson (Eds.), The Gale Encyclopedia of Children's Health (Vol. 1, pp. 88-92). Michigan: Thomson Gale.

The Tale of 4 Hormones- Normal Menstrual Cycle. (n.d.). Retrieved February 23, 2012, from http://pcosjournal.com/hormones-normal-menstrual-cycle/

Turkington, C. A. (2002). Amenorrhea. In J. L. Longe (Ed.), The Gale Encyclopedia of Medicine (2nd ed., Vol. 1, pp. 146-148). Michigan: Gale Group.

Nelson, L. M., M.D. (n.d.). Amenorrhea. Retrieved from WEB M.D, LLC website:      http://www.emedicinehealth.com/script/main/art.asp?articlekey=59246&pf=3&pa

Slide 8 Image: http://img.medscape.com/pi/emed/ckb/obstetrics_gynecology/252558-1336968-276110-1622624.jpg