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Supervised by:

Ismu Setyo Djatmiko, dr., Sp.OG

Presented by:

Ikrom Mullah






Amenorrhea may also occur if the ovaries fail to produce a sufficient amount of estradiol despite normal gonadotropin stimulation by the hypothalamus and pituitary. pituitary and ovaries form HPO axis. where it binds to the GnRH receptor to stimulate gonadotropin. a defect of the cervix. In some cases. uterine septum. these hormones stimulate the ovaries to synthesize and secrete steroid hormones. The reason according to the physiology of menstruation. and imperforate hymen. these cells secrete gonadotropin follicle-stimulating hormone (FSH) and luteinizing hormone (LH). CHAPTER I INTRODUCTION Menstruation is a regular cycle of sloughing of the uterine lining as a result of the interaction of hormones produced by the hypothalamus. then there are four compartments with disorders resulting in amenorrhea . the hormonal regulation and reaction to feedback. pituitary and ovaries all be functioning normally. located in the central nervous system. pituitary and ovaries. but amenorrhea may occur due to uterine abnormality like adhesion in the endometrial cavity. Secondary amenorrhea is a woman of reproductive age who have had menstrual periods but stopped three months in a row. In response to stimulation by GnRH. so that estradiol production is inadequate and there is a failure or a failure of ovulation and progesterone production. release of gonadotropin-releasing hormone (GnRH) continuously. Amenorrhea occurs if the hypothalamus and pituitary failure to provide gonadotropin stimulation of the ovary. The hypothalamus. pituitary and ovaries. Any disruption of this axis can lead to amenorrhea. the hypothalamus. which is transported to the anterior pituitary. Furthermore. Stimulation and inhibition of negative completes the path between the hypothalamus. The hypothalamus. The release of hormones through the axis (HPO) hypothalamic-pituitary-ovarian negative feedback regulated by steroid hormones in the anterior pituitary gonadotropin and direct inhibition at the level of the hypothalamus.

Patient were also admitted using the KB injections in 2015. Patients admitted to taking the pills KB in 2011. with complaint no menses since 3 months ago. History of Past Illnesses History of chronic hypertension : denied History of kidney disease : denied History of diabetes mellitus : denied History of auto immune disease : denied History of asthma : denied History of allergy : denied History of surgery : denied History of cancer : denied Familial History History of hypertension : denied History of kidney disease : denied History of diabetes mellitus : denied History of auto immune disease : denied History of cancer : denied . dyspnea. The patient denied any vaginal discharge. and others. CHAPTER II CASE REPORT Patient’s Identity Name : Mrs. Syamsudin. She denied any other complaints. SH’s obstetrician & gynecologist polyclinic. the breast feels tight. 2017 Date of examination : March 15th. Patient were not breastfeeding. History of Present Illness Patient came to the RSUD R. such as fever. Patient did not do a pregnancy test for 3 months. Patient do not complain of symptoms of nausea and vomiting in the morning. Previous patient regular periods every month since age 12 th with long period 7 days and felt pain during menstruation. rapid fatigue and frequent urination. H Age : 30 year-old Nationality : Indonesian Address : Sagaranten Marital status : Married Occupation : Housewife Religion : Moslem Date of admission : March 15th. and also urinary and defecating problems. 2017 History Taking Chief Complaint Patient came to Polyclinic with complaint no menses since 3 months ago. pain during having sex.

Marital History Married once. 2004 Aterm Vaginal delivery Boy 3000 g 2. wheezing -/- Abdomen Inspection : Flat. murmur -. CRT < 2 seconds . edema -/-/-/-. icteric sclera -/- Mouth : wet oral mucosa membrane Heart : regular 1st and 2nd heart sounds.83 kg/m2 General Examination Eyes : anemic conjunctiva -/-. mass (-) Palpation : mass (-). 7 days duration and with history of pain during menstruation Amount of menstrual blood : 2-3 normal pads / day ( ± 60 cc ) LMP : 3 months ago Contraception History History of using contraception pills for 7 years in 2011. she has been married for 15 years Obstetric History Birth No Date Gestational Age Labor History Sex Weight 1. Menstruation History Menarche : 12 years old Menstrual cycle :regularly every 28-30 days. History of using contraception hormone for 1 years in 2015. rhonchi -/-. 2014 Aterm Vaginal delivery Girl 2800 g Physical Examination General condition : mildly ill appearance Consciousness : compos mentis Blood pressure : 120/80 mmHg Heart rate : 88 bpm Respiratory rate : 20x/minute Temperature : 37°C Weight : 50 kg Height : 155 cm BMI : 20. gallop - Lung Inspection : symmetric chest expansion in breathing Percussion : resonant on both lungs Auscultation : vesicular breath sounds +/+. tenderness (+) Auscultation : bowel sound (+) Extremities : warm.

felt mass at the left adnexa with pain (-) Laboratory (March 15th 2017) Types Results Units Normal Value Urine BhCg Urine Negative (-) USG examination (March 15th 2017) . felt mass at the right adnexa with pain (-). stoll cell -. vaginal discharge - Vaginal toucher : cervical motion tenderness -. blood (-).Gynecologic Examination LMP : 3 months ago Fundal height : difficult to examined Inspection : vulvovagina within normal limit. erotion -. tissue -. vaginal discharge (-) Inspeculo : blood -.

P2A0. Uterus : no mass. no gravid. H . 30 years old. with Secondary Amenorrhea Management Primolut N 3 x 1 tab . within normal limit Working Diagnosis Mrs.

Prognosis Quo ad vitam : ad bonam Quo ad functionam : dubia ad bonam Quo ad sanationam : dubia ad bonam .