闭经(英语).ppt

Dr.Mohammed AbdallaObst.Gyn.Specialist Egypt ,Domiat G. Hospital Hamoda1992@ ASSESSMENT OF A CASE OF AMENORRHEA AMENORRHEA Amenorrhea is the absence or abnormal cessation of the menses. A patient is diagnosed with primary amenorrhea if she has not reached menarche by age 15.1 She meets the criteria for secondary amenorrhea if established menses have ceased for longer than 6 months Etiology of Amenorrhea Primary?? ?Gonadal failure(43%)? Congenital absence of uterus and vagina(15%)? Constitutional delay(14%) Secondary??? Chronic anovulation(39%) ?Hypothyroidism / hyperprolactinemia(20%)? Weight loss/anorexia(16%) THE ASSESSMENT Primary amenorrhea vagina no yes congenital uterovaginal agenesis imperforate hymen complete transverse vaginal septum Pubic hair Estrogenized breasts have developed the (MPA) challenge abnormal ovaries abnormal hormonal stimulation of normal ovaries FSH Level Chromosome Analysis no no yes complete androgen insensitivity syndrome (CAIS) + - high low Secondary Amenorrhea incidence 1% of women of reproductive age. The most common cause of secondary amenorrhea in reproductive age women is pregnancy and this should always be excluded by physical exam and laboratory testing for the pregnancy hormone - HCG. History A good history can reveal the etiologic diagnosis in up to 85% of cases of amenorrhea. Galactorrhea hot flashes, breast atrophy and decreased libido Certain medications A large amount of weight loss or gain Anorexia nervosa Cushings disease ?and hypothyroidism Sheehans syndrome. Ashermans syndrome Amenorrhea following cervical conization Following discontinuation of oral contraception History Physical examination Signs of androgen excess The breast exam may reveal galactorrhea Estrogen deficiency may be suggested on pelvic exam by a smooth vagina that lacks the normal rugae (wrinkles) and a dry endocervix with no mucous what the doctor will do next? If the history and physical exam are suggestive of a certain