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22. Amenorrhea
Hi guys I am back with another video , in this video we will be discussing about the amenorrhea, so what Is amenorrhea? Amenorrhea means absence of menses. Now let us recall the events of puberty , the first event of puberty is the physical growth . The specific eve events of puberty for girls are : Thelarche that is breast development, pubarche that is growth of pubic and axillary hair , sudden linear spurt in height , followed by periods or menarche . The normal age of puberty is from 10 to 12 years. Now amenorrhea can be divided into two types. One is primary amenorrhea and the second is secondary amenorrhea . What is primary amenorrhea? It basically means delayed puberty that can be seen in a teenager that is a child who has never got her periods . Now how do we know if that girl is going through delayed puberty ?, absence of menstruation till 13 years if there is an absence of the secondary sexual characters . Absence of menstruation till 15 years if there is a presence of the secondary sexual characters. Now let us know the diagnosis: the first one is pregnancy test , examination should be done which includes the examination of breast development , pubic hairs and the vaginal development. Third one is Rule out the uterine absence by doing the per vaginal examination , the test which can be done here includes LH , FSH , CBC , Karyotype, ultrasound . Let us know more about primary amenorrhea: secondary sexual characters if present but there are no uterus causes complete mullerian agenesis , now if the uterus is present but the defects are anatomical . The defects can be transverse vaginal septum , imperforate hymen. In case of normal anatomy it can cause due to increased hypothyroidism , increase In LH and FSH , decrease in LH and FSH.
Now let us discuss more about the secondary amenorrhea , in case of secondary amenorrhea if the pregnancy test is negative rule out the hyperthyroidism and hyperprolactinemia , do the progesterone challenge test . If periods occur then it is PCOD and if periods doesn’t occur we have to do the estrogen + progesterone challenge test . Now in this test if there are periods and it is the case of increase in LH and FSH which causes pre mature ovarian failure . decrease in LH and FSH causes CNS tumors , chronic illness. And if there are no periods we have learnt earlier that it is the case of Asherman syndrome . Let us come to know about the common Etiology of secondary amenorrhea , they are : pregnancy , hypothyroid, chronic illness , hyper prolacemia, thyroid diseases, PCOS ,cushing’s syndrome. This is all about this topic , thank you !
