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hello I would like to discuss primary
and secondary aim in area with you this
is often tested on the USMLE so pay
close attention let's review what a
normal menstrual cycle is like it's
between 21 and 35 days there is another
lecture about AUB if you'd like to find
out more I'd like to discuss the
terminology that we use i'll ago Minh
area means periods that are greater than
every 35 days apart it can also mean
less than 9 mental cycles per year poly
materia is different it actually means
that your periods come too frequently
they're less than 21 days in the
interventional bleeding menorrhagia
means you have too much flow greater
than 80 milliliters in seven days Metro
Rajah means that you have a regular
bleeding between vince's and Amon Turia
means no menses that can be either
primary or secondary and we'll find out
more in just a second remember if you'd
like to know the new terminology please
refer to the AUB lecture so this is an
overview of the hypothalamic pituitary
axis now depending on what the target
organ is there are different hormones
that come from the hypothalamus
there are different hormones organic
opens or trophic hormones that come from
the anterior pituitary and the posterior
pituitary and they have different
effects on the target organ all of these
systems may have a role in normal
menstrual sick Lissa t you can see here
the target and organ hormone production
is definitely influenced by the anterior
pituitary and the hypothalamus
let's review primary amenorrhea
in primary amenorrhea you have never had
a menstrual cycle this is pathologic if
you are aged thirteen and have no
secondary sexual characteristics to
remind you breasts axillary and pubic
hair are all secondary sexual
characteristics by age 15 even if you
have secondary sexual characteristics if
you have no menses this is pathologic
again it's very important to remember
that the hpo axis must be intact for a
young woman to have a menstrual cycle if
she has a mini Rhea something has gone
wrong at the level of the hpo axis it
could be the environment that is feeding
back information into the CNS the CNS
then obviously corresponds to the
hypothalamus the hypothalamus has to
release genetic open releasing hormone
to the anterior pituitary the anterior
pituitary you will release gannett
Atropa pnes FSH follicle stimulating
hormone and luteinizing hormone or LH to
the ovary the ovary then produces
estrogen and progesterone the uterus is
influenced by estrogen and progesterone
and the withdrawal of both of those
hormones result in a menstrual cycle
let's now go over the common causes that
we see in primary aim in areia if you
have a patient that has breast
development you should consider that
their cause of primary aim in area may
be mullerian a Genesis there is a
separate talk on malaria a Genesis or
variants in another lecture if you'd
like more information also and urine
sensitivity can also
as primary aim in areia there is another
lecture set where you can learn more
about complete and partial androgen
insensitivity also women may have
anatomic factors that actually prevent
menses one of those is a vaginal septum
they may also have an imperforate hymen
or they may overall have constitutional
delay if you have no breast development
likely you will have a high FSH or
follicle stimulating hormone this can
happen in normal genetic females such as
46 xx it can also happen in 46 XY
individuals
let's also now talk about low FSH you
can typically have a low FSH with
constitutional delay this also happens
with prolactin omus and calman syndrome
you may get tested about common zone
syndrome so I will spend a little time
here these patients usually have a nas
mia which means it cannot smell they
usually have primary amenorrhea and
wounding assistants to become pregnant
should they like to become pregnant in
the future other CNS pathology can also
lead to a low FSH stress weight loss and
anorexia is typical to have a low FSH
associated with it
polycystic ovarian syndrome can also
have a normal to low FSH and again
congenital adrenal hyperplasia may have
a low FSH as well if you'd like to learn
more about CAH or control internal
hyperplasia there is a separate lecture
set for that I want to bring your
attention to a really quick mnemonic to
remember the causes of primary aim in
areia when I was a medical student it
was difficult for me to remember but I'm
gonna give you a quick tip on how you
can remember it remember xmas X is for
45 X 0 or Manas only associated with
Turner syndrome
M is for mullerian agenesis
recall that there is another lecture
about malaria Genesis that you can
review a is for androgen insensitivity
syndrome this is typical with complete
androgen insensitivity syndrome again
you
review this in another lecture set
lastly S is for Swire syndrome this is
also referred to as XY gonadal dis
Genesis
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