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Amenorrhea: Menstrual Cycle (Review)
Amenorrhea: Menstrual Cycle (Review)
HYPOTHALAMUS-PITUTARY-OVARIAN AXIS
PRIMARY AMENORRHEA
Absence of menses (IN WOMEN) by 16 years of age in the presence of normal secondary sexual
characteristics.
Absence of menses (IN WOMEN) by 14 years of age when there is no visible secondary sexual
characteristics.
SECONDARY AMENORRHEA
Absence of menstruation for three normal menstrual cycles of six months after menarche.
No Yes
FSH and LH <5 IU/L FSH >20 IU/L uterus absent/abnormal uterus present/Normal
LH >40 IU/L
karyotype analysis
46XY 46XX No Yes
premature turner’s
ovarian syndrome
failure
HYPOGONADOTROPIC HYPOGONADISM
When the hypothalamus fails to secrete adequate amounts of GnRH
When the pituitary disorder associated with inadequate production or release of pituitary gonadotropins
is present.
1. Physiology delay
o Most common manifestation
o Delayed reactivation of the GnRH pulse generation
2. Kallman’s Syndrome
o 2nd most common
o Insufficient pulsatile secretion of GnRH
3. Central Nervous System Tumor
o Most common is craniopharyngioma
ANDROGEN INSENSITIVITY
o Phenotypically female, genotypically male (XY)
o Defect in the androgen receptor gene located in the X Chr
o Anti mullerian hormone is present
o Testes, rather tha ovaries, arepresent in the abdomen