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hello I would like to discuss primary
and secondary amenorrhea 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 all ago malaria
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 are less than 21 days in the
interventional bleeding menorrhagia
means you have too much flow greater
than 80 milliliters and seven days Metro
Rajah means that you have a regular
bleeding between vincey's and amenorrhea
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 AUV
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 pituitary as you see here there
are different hormones organ editor
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 solicit II 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 has 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 materia
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 will
release Gananoque opens SSH follicle
stimulating hormone and luteinizing
hormone or LH to the ovary the ovaries
in 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 with common
causes that we see in primary aim in
areia if you have a patient that has
breast development you consider that
their cause of primary aim in area may
be mullerian a Genesis there is a
separate talk on mullerian a Genesis or
variants in another lecture if you'd
like more information also androgen
insensitivity can also present as
primary aim in area 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 SSH or
follicle stimulating hormone this can
happen in normal genetic females such as
46 X X 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
a this also happens with prolactin Oma's
and calman syndrome you may get tested
without common salt syndrome so I will
spend a little time here these patients
usually have a nas mia which means they
cannot smell
they usually have primary amenorrhea and
will need assistance 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 s SH
associated with it polycystic ovarian
syndrome can also have a normal to low
SSH and again congenital adrenal
hyperplasia may have a low FSH as well
if you'd like to learn more about CAH or
continual adrenal 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 going to 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 can 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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