Description
Amenorrhea refers to the absence of menstrual periods in women of reproductive age and can be classified as either primary or secondary. Clinical features of amenorrhea may include hot flashes, vaginal dryness, breast changes, headaches, and hair loss, depending on the underlying cause such as hormonal imbalances, stress, or anatomical abnormalities. Diagnosis involves a thorough medical history, physical examination, and tests including hormone levels (e.g., FSH, LH, estradiol, thyroid function tests) and imaging studies (e.g., ultrasound, MRI). Treatment depends on the cause and may include lifestyle modifications, hormone replacement therapy, medications to induce ovulation, or surgical intervention in cases of structural abnormalities. Management aims to address underlying factors, restore menstrual function, and address any associated symptoms or complications of amenorrhea. Regular follow-up and monitoring are essential to assess treatment efficacy and address any new concerns or changes in symptoms.
Résumé
- Amenorrhea, the absence of menstruation, is defined as no menstruation before age 14 without secondary sexual characteristics or no menstruation by age 16 with normal growth and development. Secondary amenorrhea involves the absence of menstruation for six months or more after previously menstruating, excluding pregnancy, lactation, hysterectomy, or postmenopausal conditions. Common causes include polycystic ovary syndrome (PCOS), hypothalamic amenorrhea, hyperprolactinemia, and ovarian failure.
- Primary amenorrhea can stem from outflow tract anomalies like imperforate hymen or vaginal agenesis, end-organ problems (uterus), or central regulatory disorders. Clinical approach involves early evaluation if no sexual development occurs. History taking is crucial, asking specific questions about menstrual cycles and development. Examination is key to identify features like blood collection in the vagina or uterus due to outflow tract issues.
- Cryptomenorrhea, where menstruation occurs but is obstructed, presents with lower abdominal pain and urinary issues. Imperforate hymen and vaginal atresia can cause blood accumulation, necessitating surgical intervention. Absence of the vagina, potentially linked to Mullerian anomalies, may require reconstructive surgery. Androgen insensitivity, where the phenotype is female but the genotype is male (XY), presents with tall stature, minimal body hair, and potentially testicular presence.
- Asherman's syndrome, often a result of overzealous curettage, causes secondary amenorrhea due to endometrial destruction and fibrosis. It can be treated with hysteroscopic synechia release, IUD placement, hormonal therapy, or stem cell therapy. Chromosomal abnormalities, such as Turner syndrome (45 XO), cause primary amenorrhea, short stature, and abnormal physical features. Mosaic chromosome patterns can lead to secondary amenorrhea and premature menopause.
- Hyperprolactinemia, treatable with dopamine agonists, often presents with pituitary adenomas and requires MRI evaluation. Sheehan syndrome, resulting from postpartum pituitary necrosis, can lead to secondary amenorrhea following severe postpartum hemorrhage. Hypothalamic disorders, often linked to stress, may resolve with lifestyle modifications or hormonal therapy. Extreme weight loss or eating disorders can also induce amenorrhea.
- Investigations include serum prolactin, thyroid function tests, and karyotyping to rule out chromosomal abnormalities. Treatment options range from lifestyle modifications and hormonal therapies to surgical interventions like vaginal reconstruction, uterine transplants, and gonadectomy for XY individuals. A multidisciplinary approach involving gynecologists and endocrinologists improves patient outcomes.
Exemple de certificat
À propos des intervenants
Dr Lavanya Kiran
Chirurgien laparoscopique consultant principal, hôpital Kauvery, Bangalore
Divulgation financière
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