Amenorrhea (Gynecologists' Lecture)
Summary
TLDRThis video script explains amenorrhea, the absence of menstruation, which can occur before puberty, during pregnancy, or after menopause. It discusses two types: primary amenorrhea, where menstruation never starts, and secondary amenorrhea, where it stops in someone previously menstruating. The script explores causes, including Turner syndrome, Mullerian agenesis, androgen insensitivity syndrome, polycystic ovary syndrome (PCOS), and functional hypothalamic amenorrhea. Diagnostic methods include hormone level testing, karyotyping, and ultrasounds. Treatments vary depending on the cause and can involve hormone therapy, surgery, or medication.
Takeaways
- 🩸 Amenorrhea refers to the absence of menstruation, which is normal before puberty, during pregnancy, lactation, and after menopause, but can also be caused by medical conditions.
- 🧠 Menstruation is regulated by the hypothalamus and pituitary gland, which release hormones like GnRH, FSH, and LH to control ovarian and uterine cycles.
- 🥚 The menstrual cycle consists of the follicular phase (ovarian follicles develop) and luteal phase (corpus luteum produces progesterone). The uterine cycle includes the menstrual phase (shedding of the endometrial lining) and proliferative/secretory phases.
- 👶 Primary amenorrhea occurs when menstruation has not begun by age 16, with Turner syndrome being the most common cause due to the absence or partial absence of an X chromosome.
- 🌱 Mullerian agenesis is another cause of primary amenorrhea where the reproductive organs (uterus, cervix) are absent or underdeveloped, though ovarian function remains normal.
- 👩⚕️ Secondary amenorrhea refers to the absence of menstruation for at least three months in someone with previous normal cycles, with pregnancy being the most common cause.
- ⚖️ Functional hypothalamic amenorrhea occurs due to stress, weight loss, or excessive exercise, leading to a decrease in GnRH and estrogen production.
- 🌿 Polycystic ovary syndrome (PCOS) leads to an imbalance in LH and FSH, causing ovulation issues and elevated testosterone levels.
- 🔬 Endocrine disorders like hyperprolactinemia (high prolactin levels) and hypothyroidism can also lead to secondary amenorrhea due to disrupted hormone production.
- 🩺 Treatment of amenorrhea depends on the underlying cause, ranging from hormone replacement therapy to surgery, psychotherapy, or addressing fertility issues.
Q & A
What is amenorrhea and when does it occur naturally?
-Amenorrhea is the absence of menstruation. It naturally occurs before puberty, during pregnancy, during lactation, and after menopause.
What are the two types of amenorrhea and how are they different?
-The two types of amenorrhea are primary and secondary. Primary amenorrhea occurs when menstruation never starts by a certain age, while secondary amenorrhea happens when menstruation stops in someone who previously had regular periods.
What role do the hypothalamus and pituitary gland play in the menstrual cycle?
-The hypothalamus secretes gonadotropin-releasing hormone (GnRH), which triggers the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both of which are essential for regulating the menstrual cycle.
What happens during the follicular phase of the menstrual cycle?
-During the follicular phase, several follicles in the ovaries start developing, with one becoming the dominant follicle. These follicles secrete estrogen, which helps regulate FSH levels.
What are the menstrual and proliferative phases in the uterus?
-The menstrual phase is when the functional layer of the endometrium is shed, leading to menstruation. The proliferative phase follows, during which estrogen causes the endometrium to thicken and develop glands and spiral arteries.
What causes primary amenorrhea in Turner syndrome?
-In Turner syndrome, one X chromosome is missing or partially absent, leading to the early depletion of ovarian follicles. This causes menopause before menarche (the first menstruation).
What are some common causes of secondary amenorrhea?
-Common causes of secondary amenorrhea include pregnancy, functional hypothalamic amenorrhea, polycystic ovary syndrome (PCOS), hyperprolactinemia, and premature ovarian failure.
How does polycystic ovary syndrome (PCOS) lead to amenorrhea?
-In PCOS, there is an imbalance between LH and FSH levels, causing ovulation not to occur. Without ovulation, progesterone levels don't rise, leading to a lack of menstruation.
How can endocrine disorders like hypothyroidism cause amenorrhea?
-Hypothyroidism leads to increased levels of thyrotropin-releasing hormone (TRH), which stimulates prolactin production. Elevated prolactin inhibits GnRH production, causing a disruption in the menstrual cycle.
What are some diagnostic tools used to identify the cause of amenorrhea?
-Diagnostic tools include hormone level tests (FSH, LH, estrogen, prolactin, thyroid hormones), karyotyping for genetic disorders, ultrasound for structural issues, and hysteroscopy for detecting intrauterine adhesions.
Outlines
🚺 Menstrual Cycle and Amenorrhea
This paragraph discusses the menstrual cycle and the conditions of amenorrhea. Menstruation is typically absent before puberty, during pregnancy and lactation, and after menopause. Primary amenorrhea refers to the absence of menstruation by age 16, while secondary amenorrhea is the sudden cessation in someone who has previously menstruated. The menstrual cycle is regulated by the hypothalamus and pituitary gland, which control the secretion of hormones necessary for ovulation and the uterine cycle. The paragraph also explains the phases of the menstrual cycle, including the follicular phase, menstrual phase, proliferative phase, and luteal phase. It further delves into the causes of primary amenorrhea, such as Turner syndrome, Müllerian agenesis, androgen insensitivity syndrome, and endocrine disorders like Coleman syndrome.
🤰 Causes of Secondary Amenorrhea
The second paragraph focuses on secondary amenorrhea, defined as the absence of menstrual bleeding for at least three cycles or six months in someone who previously had regular cycles. It outlines the various causes, including pregnancy, functional hypothalamic amenorrhea due to factors like weight loss, nutritional deficiencies, and stress, polycystic ovary syndrome (PCOS), pituitary gland issues like hyperprolactinemia, hypothyroidism, premature ovarian failure, and Asherman syndrome. Each cause is briefly explained, detailing how it disrupts the normal menstrual cycle and the hormonal imbalances that result.
🩺 Diagnosis and Treatment of Amenorrhea
The final paragraph discusses the diagnosis and treatment of amenorrhea. It begins by describing the diagnostic process, which includes ruling out pregnancy and testing serum levels of various hormones, as well as karyotyping for genetic disorders. Diagnostic tools such as ultrasound and hysteroscopy are also mentioned. The paragraph then outlines potential treatments based on the underlying cause, including hormone replacement therapy, dopamine agonists for prolactinomas, surgery for intrauterine adhesions, and psychotherapy for stress-related amenorrhea. The summary concludes with a recap of the causes of both primary and secondary amenorrhea and the diagnostic methods used to identify them.
Mindmap
Keywords
💡Amenorrhea
💡Primary Amenorrhea
💡Secondary Amenorrhea
💡Hypothalamus
💡Follicle-Stimulating Hormone (FSH)
💡Luteinizing Hormone (LH)
💡Turner Syndrome
💡Müllerian Agenesis
💡Polycystic Ovary Syndrome (PCOS)
💡Prolactinoma
Highlights
Amenorrhea refers to the absence of menstruation, which can be normal before puberty, during pregnancy, lactation, and after menopause.
Primary amenorrhea occurs when menstruation hasn't started by age 16 despite normal growth or by age 13 with no signs of puberty.
Secondary amenorrhea is defined as the absence of menstruation for at least three cycles in someone who previously had regular periods.
The hypothalamus and pituitary gland control menstruation through the secretion of hormones like GnRH, FSH, and LH.
Turner syndrome, where one X chromosome is missing or partially absent, is the most common cause of primary amenorrhea.
Mullerian agenesis is another cause of primary amenorrhea, where the uterus and part of the vagina fail to develop, but ovaries are functional.
Androgen insensitivity syndrome can also cause primary amenorrhea; individuals have XY chromosomes but lack functional androgen receptors.
Functional hypothalamic amenorrhea, a common cause of secondary amenorrhea, can be triggered by weight loss, stress, or excessive exercise.
Polycystic ovary syndrome (PCOS) is linked to secondary amenorrhea due to hormonal imbalances between LH and FSH.
Hyperprolactinemia, often caused by a benign pituitary tumor, is another contributor to secondary amenorrhea by suppressing GnRH.
Premature ovarian failure can result in early menopause and secondary amenorrhea due to accelerated depletion of ovarian follicles.
Asherman syndrome, caused by scar tissue in the uterus, is a structural reason for secondary amenorrhea, often following uterine procedures.
The most common symptom of both primary and secondary amenorrhea is the absence of menstruation, with other symptoms varying by cause.
Diagnosis of amenorrhea includes ruling out pregnancy, hormone level assessments, and imaging techniques like ultrasound for structural issues.
Treatment for amenorrhea depends on the underlying cause, including hormone therapy, surgery, dopamine agonists for prolactinomas, and psychotherapy.
Transcripts
amenorrhea means no menstruation it's
normally before puberty during pregnancy
and lactation and after menopause
sometimes though menstruation either
never starts which is called primary
amenorrhea or suddenly stops in a person
who's previously menstruating which is
called secondary amenorrhea
now menstruation and the menstrual cycle
as a whole are controlled by the
hypothalamus and the pituitary gland all
the way up in the brain
the hypothalamus secretes gonadotropin
releasing hormone or gnrh which makes
the nearby anterior pituitary gland
release follicle stimulating hormone or
fsh and luteinizing hormone or lh
in the first two weeks of an average
28-day cycle the ovaries go through the
follicular phase
meaning that out of the many follicles
scattered throughout the ovaries a
couple of them enter a race to become
the dominant follicle that will be
released at ovulation
all the developing follicles secrete
loads of estrogen which negatively
inhibits pituitary fsh
in the meantime the uterus goes through
two phases the menstrual and the
proliferative phase
during the menstrual phase the
functional layer of the endometrium is
shed and eliminated through the vagina
leading to menstruation which lasts an
average of five days
it's followed by the proliferative phase
during which the rising levels of
ovarian estrogen make the functional
layer of the endometrium thicken and
sprout endometrial glands
additionally spiral arteries emerge to
nourish the growing functional
endometrium
after ovulation the ovaries enter the
luteal phase which lasts for the two
weeks following ovulation
during the luteal phase the remnant of
the ovarian follicle called the corpus
luteum makes progesterone which
negatively inhibits pituitary lh
progesterone makes the endometrium go
through the secretory phase during which
it thickens some more and spiral
arteries continue to grow
if the egg is not fertilized by a sperm
estrogen and progesterone levels slowly
decrease
when progesterone reaches its lowest
level the spiral arteries collapse and
the functional layer dies off and is
eliminated through menstruation which
marks the beginning of a new menstrual
cycle
okay now coming back to amenorrhea
primary amenorrhea is when a female
hasn't had her first menstruation called
menarche by age 16 despite normal growth
and having started puberty
primary amenorrhea is also suspected
when a female hasn't had menarche by age
13 and doesn't show signs of puberty
which include developing secondary
sexual characteristics like breasts
the most common cause of primary
amenorrhea is turner syndrome where one
x chromosome is either completely or
partially absent
the most common karyotype is 45x
which means the person has 45
chromosomes of which only one is an x
chromosome
with turner syndrome the ovaries are
replaced by street gonads or
functionless fibrous tissue
this happens because the missing x
chromosome leads to accelerated ovarian
follicle depletion so that by two years
old none are left essentially causing
menopause before menarche
no ovarian follicles also means no
estrogen and progesterone which leads to
high levels of fsh and lh
the second most common cause of primary
amenorrhea is mullerian a genesis which
is also called meijer rokitansky kester
hauser syndrome
in this case the muellerian duct system
doesn't develop properly in a
biologically female fetus
the mullerian duct system is responsible
for the development of the uterus cervix
and upper two thirds of the vagina so
these organs may be absent or
rudimentary and obstructed which
explains the absence of menses
but the ovaries develop normally in
these individuals and the ovarian
follicles make normal amounts of
estrogen and progesterone so there are
normal levels of fsh and lh
a rare cause of primary amenorrhea is
androgen insensitivity syndrome
in this case the individual is
biologically male which means they have
a 46 xy karyotype but their androgen
receptors don't respond to testosterone
so they don't have a uterus fallopian
tubes or ovaries which explains the
absence of menses but they have
testicles which are usually in the
abdomen or inguinal canal and they make
up the normal amount of testosterone for
a biologically male individual so fsh
and lh levels are normal
some of that testosterone gets converted
into estrogen so these people have
female external genitalia and female
secondary sex characteristics
finally endocrine disorders can also
cause primary amenorrhea
these include coleman syndrome where
gnrh producing neurons fail to migrate
from the nose region to the hypothalamus
during fetal development this causes low
levels of gnrh fsh and lh
and as a consequence low estrogen so
puberty either never starts or is
incomplete
okay now let's switch gears and look at
causes of secondary amenorrhea which is
defined as no menstrual bleeding for at
least three normal menstrual cycles in a
female who previously had regular cycles
or for six months for females who used
to have irregular cycles
there are many causes of secondary
amenorrhea and when they occur before
menarche all of these can also cause
primary amenorrhea
the most common cause of secondary
amenorrhea is pregnancy
next there's functional hypothalamic
amenorrhea which is when there's a
decrease in gnrh secretion leading to
low levels of lh fsh and estrogen
often this is due to weight loss from
anorexia nutritional deficiencies like
excessively low fat consumption
prolonged periods of strenuous exercise
or severe physical or emotional stress
another condition that affects the
hypothalamic pituitary ovarian axis and
can be responsible for secondary
amenorrhea is polycystic ovary syndrome
now it's not clear exactly what causes
pcos but there seems to be an imbalance
between lh and fsh levels
specifically ovulation doesn't occur so
progesterone levels don't rise enough to
inhibit lh production
this leads to an increase in the
production of lh compared to fsh
so there's an elevated lh to fsh ratio
additionally because there's
post-ovulatory rise and fall in
progesterone there's no menstruation
issues with the pituitary gland can also
cause secondary amenorrhea one cause is
hyperprolactinemia or excessive
prolactin secretion by pituitary
lactotroph cells
which is frequently seen with a benign
pituitary tumor called a prolactinoma
high prolactin levels inhibit
hypothalamic gnrh production
which inhibits ovulation and
menstruation
interestingly
hypothyroidism a condition where there's
low levels of thyroid hormones can also
cause amenorrhea
this is because low thyroid hormone
levels tell the hypothalamus to release
more thyrotropin releasing hormone or
trh and tell the pituitary to release
more thyroid stimulating hormone or tsh
when this happens trh also stimulates
prolactin release so hyperprolactinemia
and amenorrhea occur
now sometimes secondary amenorrhea can
occur because of premature ovarian
failure which is when the ovarian
follicles undergo accelerated atresia
and get depleted before the age of 40
resulting in early menopause
this leads to low serum estrogen and
high fsh and lh
finally a structural cause of secondary
amenorrhea is intrauterine adhesions or
asherman syndrome which is when there's
scar tissue inside the uterine cavity
typically in a female that's undergone
uterine instrumentation in the past
amenorrhea can occur because there's so
much scar tissue that there's no
functional endometrium left or because
the presence of scar tissue makes the
endometrium refractory to hormonal
stimulation
the one symptom of both primary and
secondary amenorrhea is well the absence
of menstruation
additional symptoms depend on the cause
individuals with turner syndrome have a
short stature
absent secondary sex characteristics and
a wide or webbed neck
eulerian a genesis might cause
dysperunia or painful sexual intercourse
and infertility
with androgen insensitivity syndrome
individuals typically have sparse body
hair and little to no pubertal acne
with coleman syndrome there may be
anosmia or absent sense of smell
because the neurons responsible for
olfaction are closely related to the
ones that release gnrh
with functional hypothalamic amenorrhea
due to anorexia there's significant
weight loss and decreased bone density
which can cause fractures
with polycystic ovary syndrome the
ovarian follicles secrete too much
testosterone causing hirsutism or
excessive hair growth on the chin and
upper lip chest and back
with a prolactinoma there might be
galacteria or abnormal milk production
with premature ovarian failure there may
be additional symptoms like hot flashes
or vaginal dryness
with intrauterine adhesions there could
be infertility
the first step in diagnosing primary or
secondary amenorrhea is to rule out
pregnancy with a pregnancy test
if that's negative diagnosis requires
serum levels of fsh lh
estrogen prolactin
tsh and testosterone
a karyotype can be done for turner
syndrome and androgen insensitivity
syndrome
an ultrasound can show if there are
structural issues with the vagina and
the uterus which suggests mullerian
agenesis or if there's no uterus and
intra-abdominal testicles are found
that suggests androgen insensitivity
syndrome
intrauterine adhesions can be visualized
through hysteroscopy
treatment depends on the underlying
condition
hormone replacement therapy like
combined oral contraceptives can be
useful for individuals with turner
syndrome polycystic ovarian syndrome or
premature ovarian failure
for a prolactinoma dopamine agonists
like cabergoline can be used because
they inhibit prolactin secretion just
like dopamine naturally would and they
shrink the adenoma
surgery can be used to remove
intrauterine adhesions and to help
correct some of the structural issues in
mularian agenesis
in some cases psychotherapy can also be
useful as well as treatment for the
related fertility issues
alright as a quick recap amenorrhea is
the abnormal absence of menstruation in
females of reproductive age it can be
primary in which menstruation never
started or secondary in which case
regular menstruation has stopped in a
female who is previously menstruating
causes of primary amenorrhea include
turner syndrome muellerian agenesis
androgen insensitivity syndrome and
endocrine disorders like coleman
syndrome
causes of secondary amenorrhea can also
cause primary amenorrhea and they
include functional hypothalamic
amenorrhea polycystic ovary syndrome
hyperprolactinemia
premature ovarian failure and asherman
syndrome
other associated symptoms serum fsh lh
estrogen and testosterone as well as an
ultrasound or a karyotype can be used to
identify the underlying condition
Посмотреть больше похожих видео
Precocious puberty (Year of the Zebra)
PCOD || Gynecology
⛔️ Tibolona ⛔️ Você Quer Saber O Que é e Para Que Serve a Tibolona? 🔝 Dra. Vanderléa Coelho
Genetics - Mutations and their Types - Lesson 20 | Don't Memorise
PCOS Explained: How to Identify and Diagnose
Delayed puberty - causes, symptoms, diagnosis, treatment, pathology
5.0 / 5 (0 votes)