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Amenorrhea*Primary amenorrhea: .Investigations include serum FSH .Is associated with karyotype 45 XO .May be due to congenital adrenal virilism (hyperplasia) .May be due to Mullerian duct fusion failure *Cause primary amenorrhea: .Cryptomenorrhea (imperforate hymen) .Testicular feminization syndrome .Turner's syndrome .Gonadal agenesis (Pituitary tumor) *Absence of vagina is common in Mullerian atresia with absent uterus *An imperforate hymen in a girl may be associated with: .Retention of urine .Hematocolpos .Periodical abdominal pain (back pain) .Amenorrhea . constipation, nausea, and diarrhea *Secondary amenorrhea: .May be due to thyrotoxicosis .May be due to anorexia nervosa .Investigations include prolactin levels .Oral contraceptives can be used in treatment *Causes secondary amenorrhea: .Lactation (breast feeding) .Pituitary failure .Early menopause .Pregnancy (M.C.C) *Investigations is necessary in patients with primary amenorrhea (Chromosomal analysis) *In secondary amenorrhea, elevated FSH over 40 nmol/u, indicates to (Ovarian failure or resistance) *Raised FSH levels are found in: .Post menopausal woman .Turner's syndrome .Gonadal dysgenesis .Kleinfelter's syndrome *Signs of virilism (virilization) include: .Excessive body hair .Muscle development .Deepening of the voice .Clitoromegaly *The most common pelvic mass associated with amenorrhea in a reproductive age women is pregnancy *Cause of abnormal genital bleeding in a 13 year old girl is anovulation *Dysfunctional uterine bleeding: .It is an abnormal menstrual pattern .There is no organic disease in the uterus .It may cause menorrhagia .It may cause prolonged period *Hemorrhagic metropathia: .It is a condition of variable periods of amenorrhea .Periods are heavy, continuous and painless .It is found more common nearer the menopause .It is a feature of anovular cycles in which estrogen levels are high *The most common cause of heavy bleeding in adolescent girls is Dysfunctional uterine bleeding *Vaginal bleeding in the newborn female infant is most commonly due to Estrogen withdrawal *Drugs is commonly used for dysfunctional uterine bleeding DUB is Progesterone *Dysmenorrhea: .It is a painful menstruation .The spasmodic type is the primary .The congestive type is the secondary .Membranous dysmenorrhea is most uncommon *Spasmodic dysmenorrhea (primary): .The pain occurs with the onset of menstruation .The pain in colicky in nature .It may associate with nausea and vomiting .The pain may radiate from lower abdomen to the inner aspects of the thighs *Primary dysmenorrhea at the time of menstruation is caused by Uterine hyper contractility due to prostaglandins release *Post menopausal bleeding: .May be caused by estrogen therapy .Can only occur six months after the cessation of menses .May occur due to atrophic vaginitis .Dilatation and curettage are mandatory *causes postmenopausal bleeding: .Estrogen therapy .Atrophic changes of the vagina .Cervical malignancy (Cervical lesions) .Endometrial malignancy .Ovarian tumor (fibroid) .Prolapse of the uterus .Vaginal lesions .Gastroenterological lesions .Urinary lesions *Post menopausal bleeding is managed primarily by Dilatation and curettage (D&C)
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