Podcast
Questions and Answers
Which of the following is LEAST likely to be a common cause of secondary amenorrhea?
Which of the following is LEAST likely to be a common cause of secondary amenorrhea?
- Ovarian dysfunction
- Hypothalamic-pituitary dysfunction
- Congenital anomalies (correct)
- Asherman syndrome
A 24-year-old patient, 5'9" and 100 pounds, reports cessation of menses and has a negative pregnancy test. She is a fashion model with a history of anorexia nervosa. Which of the following is the MOST likely cause of her amenorrhea?
A 24-year-old patient, 5'9" and 100 pounds, reports cessation of menses and has a negative pregnancy test. She is a fashion model with a history of anorexia nervosa. Which of the following is the MOST likely cause of her amenorrhea?
- Ovarian dysfunction
- Hypothalamic-pituitary dysfunction (correct)
- Premature natural menopause
- Missed abortion
Which of the following factors BEST differentiates secondary from primary amenorrhea?
Which of the following factors BEST differentiates secondary from primary amenorrhea?
- Amount of bleeding at times other than menses
- History of prior menses (correct)
- Chance of future fertility
- Absence of anatomic defects
In patients experiencing hypothalamic-pituitary dysfunction, what is the MOST likely pattern of FSH and LH levels?
In patients experiencing hypothalamic-pituitary dysfunction, what is the MOST likely pattern of FSH and LH levels?
Hyperprolactinemia caused by a pituitary adenoma is frequently associated with amenorrhea and which of the following?
Hyperprolactinemia caused by a pituitary adenoma is frequently associated with amenorrhea and which of the following?
Ovarian failure is MOST likely associated with which of the following menstrual patterns?
Ovarian failure is MOST likely associated with which of the following menstrual patterns?
A 20-year-old woman, never pregnant, presents with 3 months of amenorrhea. Her periods started at 13 and had been regular. She complains of fatigue, nausea, and breast tenderness. What is the MOST appropriate initial laboratory test?
A 20-year-old woman, never pregnant, presents with 3 months of amenorrhea. Her periods started at 13 and had been regular. She complains of fatigue, nausea, and breast tenderness. What is the MOST appropriate initial laboratory test?
Which measurement is MOST helpful in differentiating hypothalamic-pituitary amenorrhea from ovarian failure?
Which measurement is MOST helpful in differentiating hypothalamic-pituitary amenorrhea from ovarian failure?
What is the MOST common cause of secondary amenorrhea?
What is the MOST common cause of secondary amenorrhea?
What is the MOST common anatomic abnormality causing secondary amenorrhea?
What is the MOST common anatomic abnormality causing secondary amenorrhea?
What is the MOST common cause of pathologic amenorrhea?
What is the MOST common cause of pathologic amenorrhea?
Disruption of pulsatile secretion of gonadotropin-releasing hormone (GnRH) directly interferes with the secretion of which hormone?
Disruption of pulsatile secretion of gonadotropin-releasing hormone (GnRH) directly interferes with the secretion of which hormone?
What typically causes the endometrial scarring characteristic of Asherman syndrome?
What typically causes the endometrial scarring characteristic of Asherman syndrome?
Which patient is MOST likely classified as having oligomenorrhea?
Which patient is MOST likely classified as having oligomenorrhea?
What is the BEST initial treatment for mild cases of intrauterine scarring?
What is the BEST initial treatment for mild cases of intrauterine scarring?
A patient with a history of irregular menses presents with secondary amenorrhea. Her BMI is 35, and she has clinical signs of hyperandrogenism. Besides a pregnancy test, what is the MOST appropriate initial laboratory test?
A patient with a history of irregular menses presents with secondary amenorrhea. Her BMI is 35, and she has clinical signs of hyperandrogenism. Besides a pregnancy test, what is the MOST appropriate initial laboratory test?
A woman has been diagnosed with functional hypothalamic amenorrhea (FHA). Which lifestyle modification is MOST likely to improve her menstrual cycles?
A woman has been diagnosed with functional hypothalamic amenorrhea (FHA). Which lifestyle modification is MOST likely to improve her menstrual cycles?
A patient presents with primary amenorrhea and normal secondary sexual characteristics. Initial workup reveals a normal karyotype (46, XX). What is the MOST appropriate next step in the evaluation?
A patient presents with primary amenorrhea and normal secondary sexual characteristics. Initial workup reveals a normal karyotype (46, XX). What is the MOST appropriate next step in the evaluation?
A patient with known PCOS presents with secondary amenorrhea. She has not been trying to conceive. What is the MOST appropriate initial management strategy?
A patient with known PCOS presents with secondary amenorrhea. She has not been trying to conceive. What is the MOST appropriate initial management strategy?
A patient using depot medroxyprogesterone acetate (DMPA) for contraception presents with amenorrhea. What is the BEST course of action?
A patient using depot medroxyprogesterone acetate (DMPA) for contraception presents with amenorrhea. What is the BEST course of action?
Flashcards
Secondary Amenorrhea
Secondary Amenorrhea
Absence of menstruation for 6 months in women who previously had regular periods.
Anorexia Nervosa & Amenorrhea
Anorexia Nervosa & Amenorrhea
A condition often linked to eating disorders that can cause amenorrhea due to hypothalamic-pituitary dysfunction.
Premature Ovarian Failure
Premature Ovarian Failure
A condition where the ovaries stop functioning before age 40, leading to decreased estrogen production.
Galactorrhea
Galactorrhea
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Oligomenorrhea
Oligomenorrhea
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Amenorrhea
Amenorrhea
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First step in amenorrhea evaluation
First step in amenorrhea evaluation
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FSH levels
FSH levels
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Pregnancy
Pregnancy
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Asherman syndrome
Asherman syndrome
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Disruption of the hypothalamic-pituitary axis
Disruption of the hypothalamic-pituitary axis
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Pulsatile secretion of gonadotropin-releasing hormone
Pulsatile secretion of gonadotropin-releasing hormone
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Dilation and curettage
Dilation and curettage
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Oligomenorrhea
Oligomenorrhea
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Study Notes
- Amenorrhea refers to the absence of menstruation
Secondary Amenorrhea
- Secondary amenorrhea is the absence of menstruation in a woman who previously had regular cycles
- Congenital anomalies are not a typical cause of secondary amenorrhea
- Hypothalamic-pituitary dysfunction, ovarian dysfunction, and Asherman syndrome are common causes
Case Study: Amenorrhea and Anorexia Nervosa
- A 24-year-old patient with a negative pregnancy test, a height of 5'9", weight of 100 pounds, and a history of anorexia nervosa is likely experiencing amenorrhea due to hypothalamic-pituitary dysfunction
Primary vs. Secondary Amenorrhea
- History of prior menses distinguishes secondary amenorrhea from primary amenorrhea
Hypothalamic-Pituitary Dysfunction
- Patients with hypothalamic-pituitary dysfunction often exhibit low levels of both FSH and LH
Hyperprolactinemia
- Hyperprolactinemia caused by a pituitary adenoma is frequently associated with amenorrhea and galactorrhea
Ovarian Failure
- Ovarian failure is associated with amenorrhea
Initial Evaluation of Amenorrhea
- A 20-year-old woman experiencing 3 months of amenorrhea after previously regular cycles (menarche at 13) and reporting fatigue, nausea, and breast tenderness should undergo a pregnancy test
Differentiating Causes of Amenorrhea
- Measuring FSH levels can help differentiate hypothalamic-pituitary amenorrhea from ovarian failure
Common Cause of Secondary Amenorrhea
- Pregnancy is the most common cause of secondary amenorrhea
Anatomic Abnormalities
- Asherman syndrome is the most common anatomic abnormality to cause secondary amenorrhea
Pathologic Amenorrhea
- Disruption of the hypothalamic-pituitary axis is the most common cause of pathologic amenorrhea
Gonadotropin-Releasing Hormone
- Disruption of the pulsatile secretion of gonadotropin-releasing hormone directly interferes with FSH secretion
Asherman Syndrome
- Dilation and curettage is the typical cause of the endometrial scarring that characterizes Asherman syndrome
Oligomenorrhea
- A 45-year-old woman with periods that occur every 45 days and last 8 to 10 days would be classified as having oligomenorrhea
Mild Intrauterine Scarring
- Dilation and curettage is the best treatment for mild cases of intrauterine scarring
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