cycle which is:
Predictable - Cyclic- SpontaneousRegulated by complex interactions of:
Hypothalamic/pituitary axis – Ovaries -Genital tract
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Menstrual cycle and Amenorrhea
Содержание
- 1. Menstrual cycle and Amenorrhea
- 2. Menstrual cycle: Regular occurrence of ovulation throughout
- 3. Length of cycle Polymenorrhoea: cycles that occur
- 4. Classic phases of the menstrual cyclesProliferative(Follicular)Secretory(luteal)Menstrual
- 5. Follicular (proliferative) phaseLasts from 1st day of
- 6. Luteal (secretory) phaseExtends from ovulation until the
- 7. Cycle interaction
- 8. Normal menstrual cycleCount from 1st day of
- 9. Amenorrhea
- 10. Слайд 10
- 11. Causes
- 12. Causes of primary amenorrhoeaChromosomal
- 13. Causes of primary amenorrhoea (continued)Ovarian
- 14. Causes of secondary amenorrhoeaPhysiological
- 15. Causes of secondary amenorrhoea (continued)Ovarian
- 16. Слайд 16
- 17. Слайд 17
- 18. Disorders of outflow tract and/or uterus
- 19. Слайд 19
- 20. CryptomenorrhoeaVaginal atresia or an imperforate hymen prevents
- 21. Absence or hypoplasia of vaginaFeatures;
- 22. Asherman’s SyndromeSecondary amenorrhoea following destruction of the endometrium by overzealous curettage
- 23. Multiple synechiae show up on hysterography
- 24. TreatmentBreak down intrauterine adhesions through a hysteroscope and insert an IUCD to deter reformation
- 25. Infections- TB- Uterine schistosomiasis
- 26. Disorders of the ovary
- 27. Disorders of the ovaryChromosomal abnormalities Failure of gonadal developmentResistant ovary syndromePremature menopause
- 28. Chromosomal Abnormalities Turner’s syndrome (45 X0)
- 29. Gonadal agenesis
- 30. Слайд 30
- 31. Слайд 31
- 32. Disorders of the pituitary
- 33. Disorders of the pituitaryPituitary tumours causing hyperprolactinaemiaOther causes of hyperprolactinaeimaSheehan’s syndrome
- 34. Pituitary tumours causing hyperprolactinaemia About 40%
- 35. BromocriptineActions Suppress prolactin secretion Reduces the size
- 36. Cabergoline Potent dopamine receptor agonist on D2
- 37. Other causes of hyperprolactinaemiaPrimary hypothyriodism Chronic renal
- 38. Empty sella syndrome Congenital incompleteness of the
- 39. Disorders of the hypothalamus
- 40. Disorders of the hypothalamusWeight loss-associated amenorrhoeaKallman’s syndrome Tumours
- 41. Disorders of the hypothalamusThe most common reason
- 42. Weight loss-associated amenorrhoea - Loss of more
- 43. Weight loss-associated amenorrhoea Oestrogen levels can be
- 44. Kallman’s syndrome A rare cause of hypogonadotrophic
- 45. TumoursCraniopharyngioma
- 46. Basic investigations of amenorrhoea
- 47. Слайд 47
- 48. Patients with normal Prolactin levels
- 49. If bleeding does not follow progestogen challenge:
- 50. Ultrasonic assessment- Assess uterus and ovary Use
- 51. Primary Amenorrhoea Workup
- 52. Thank you
- 53. Скачать презентанцию
Menstrual cycle: Regular occurrence of ovulation throughout a woman’s reproductive cycle which is: Predictable - Cyclic- SpontaneousRegulated by complex interactions
Слайды и текст этой презентации
Слайд 2
Menstrual cycle:
Regular occurrence of ovulation throughout a woman’s reproductive
cycle which is:
Predictable - Cyclic- SpontaneousRegulated by complex interactions of:
Hypothalamic/pituitary axis – Ovaries -Genital tract
Слайд 3Length of cycle
Polymenorrhoea: cycles that occur at short intervals
(less than 21 days)
Oligomenorrhoea: cycles that occur at long
intervals (more than 35 days)Menstrual cycles are most irregular during times of anovulation (2 years after menarche and 3 years before manopause)
The mean length of the cycle is 28 days ± 7 days
Слайд 5Follicular (proliferative) phase
Lasts from 1st day of menses until ovulation
Endometrial glands proliferate under influence of oestrogen
Слайд 6Luteal (secretory) phase
Extends from ovulation until the onset of menses
Endometrial
glands develop secretory status necessary for implantation of the embryo
under influence of progesterone
Слайд 8Normal menstrual cycle
Count from 1st day of flow
Normal 21-35 days
The
perfect 28 days in only 15%
Duration of blood flow 4-6days
(2-8days)Average blood loss 30ml
>80 ml menorrhagia
Constant 14 day luteal phase
Most of anovulatory cycles <20 or >40 yr age
Amount of flow dependent on how rapid endometrium sheds
Слайд 12Causes of primary amenorrhoea
Chromosomal
XO- Tuner syndrome
46, XY DSDOvotesticular DSD
Hypothalamic Physiological delay
Weight loss/ anorexia/ heavy exercise
Isolated GnRH deficiency
Congenital CNS defects
Intracranial tumours
Pituitary Partial/ total hypopituitarism
Hyperproalactinaemia
Pituitary adenoma
Empty sella syndrome
Trauma/ surgery
Слайд 13Causes of primary amenorrhoea (continued)
Ovarian
True
agenesisPremature ovarian failure
Radiation/ chemotherapy/ autoimmune
Polycystic ovaries
Virilizing ovarian tumours
Other endocrine Primary hypothyroidism
Adrenal hyperplasia
Adrenal tumour
Uterine/ vaginal Imperforate hymen
Uterovaginal agenesis
Слайд 14Causes of secondary amenorrhoea
Physiological
Pregnancy
LactationMenopause
Hypothalamic Weight loss/ anorexia
Heavy exercise
Stress
Pituitary Hyperproalactinaemia
Partial/ total hypopituitarism
Sheehan’s syndrome
Trauma/ surgery
Слайд 15Causes of secondary amenorrhoea (continued)
Ovarian
Polycystic ovary syndrome
Premature ovarian failure
Surgery/ radiotherapy/ chemotherapy
Resistant ovary syndrome
Virilizing ovarian tumours
Other endocrine Primary hypothyoidism
Adrenal hyperplasia
Adrenal tumour
Uterine/ vaginal Surgery- hysterectomy
Endometrial ablation
Progestogen intrauterine device
Asherman’s syndrome
Слайд 20Cryptomenorrhoea
Vaginal atresia or an imperforate hymen prevents menstrual loss
Features; primary
amenorrhoea in a teenage girl with normal sexual development complaining
of;- intermittent abdominal pain
- difficulty with micturition
- palpable lower abdominal swelling
- bulging, bluish membrane at lower vagina
Management: Incise membrane under aseptic conditions
Слайд 21Absence or hypoplasia of vagina
Features;
- growth, development and ovarian function
are usually normal- uterus is usually absent (if only lower 1/3 of vagina has developed) but maybe normal or rudimentary
- renal anomalies (30%)
- skeletal defects (10%)
Management; a functional vagina can be created by surgery or dilators
Слайд 22Asherman’s Syndrome
Secondary amenorrhoea following destruction of the endometrium by overzealous
curettage
Слайд 24Treatment
Break down intrauterine adhesions through a hysteroscope and insert an
IUCD to deter reformation
Слайд 27Disorders of the ovary
Chromosomal abnormalities
Failure of gonadal development
Resistant ovary
syndrome
Premature menopause
Слайд 33Disorders of the pituitary
Pituitary tumours causing hyperprolactinaemia
Other causes of hyperprolactinaeima
Sheehan’s
syndrome
Слайд 34
Pituitary tumours causing hyperprolactinaemia
About 40% of women with hyperprolactinaemia will
have a pituitary adenoma
Pituitary fossa X-rays must be taken in
all cases of amenorrhoeaIf X-rays suggest any abnormality such as
- erosion of the clinoid processes
- enlargement of the fossa
- double flooring of the fossa
CT AND MRI SCANNING AND ASSESSMENT OF THE VISUAL FIELDS ARE NECESSARY
Слайд 35Bromocriptine
Actions
Suppress prolactin secretion
Reduces the size of most prolactinomas
Dosage
Should
be increased slowly over several weeks to minimise the side-effects
Side-effects
Postural
hypotensionRole of surgery
Removal of tumours is now confined to;
patients with extrasellar manifestations (pressure on the optic chiasma)
- patients who do not respond to or can not tolerate dopamine agonist
Слайд 36Cabergoline
Potent dopamine receptor agonist on D2 receptors
- Second line
agent in prolactinomas when bromocriptine is ineffective
Слайд 37Other causes of hyperprolactinaemia
Primary hypothyriodism
Chronic renal failure
Pituitary stalk compression
Drugs (phenothiazines, haloperidol, metoclopramide, cimetidine, methyldopa, antihistamines and morphine)
Idiopathic
Слайд 38Empty sella syndrome
Congenital incompleteness of the diaphragma sellae and
the subarachnoid space extends into the fossa
- It is a
benign condition
Слайд 41Disorders of the hypothalamus
The most common reason for hypogonadotrophic secondary
amenorrhoea
Often associated with weight loss, excessive exercise or stress
Diagnosed
by exclusion of pituitary lesionsOvulation induction is not indicated unless the patient wishes to become pregnant
If progestogen challenge test is negative, there is a significant risk of osteoporosis and hormone replacement therapy should be given
Слайд 42Weight loss-associated amenorrhoea
- Loss of more than 10 kg
is frequently associated with amenorrhoea
- It usually occurs in
young women as they become obsessed with their body image and starve themselves 
Слайд 43Weight loss-associated amenorrhoea
Oestrogen levels can be profoundly suppressed
Hypothalamo-pituitary-ovarian function
is usually restored when the lost weight is regained
Ovulation induction
may be required but should be given only when weight >45 kg to avoid pregnancy risks (pre-term delivery)
Слайд 44Kallman’s syndrome
A rare cause of hypogonadotrophic hypogonadism
Primary amenorrhoea
is associated with anosmia
The underlying cause is an absence
of LHRH
Слайд 50Ultrasonic assessment
- Assess uterus and ovary
Use vaginal transducer if
possible
Useful to investigate and monitor treatment
