Medical history (history of illness) represents an important component in the diagnosis of amenorrhea. Family history Menarche age (age of first menstrual period) of mother and sister. Social history Is there any evidence of psychosocial stress or strain due to your family situation? Current medical history/systemic history (somatic and psychological complaints). When was your last … Amenorrhea: Medical History
The following are differential diagnoses separated into primary and secondary amenorrhea, respectively. Primary amenorrhea Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Laurence-Moon-Biedl-Bardet syndrome (LMBBS) – rare genetic disorder with autosomal recessive inheritance; differentiated by clinical symptoms into: Laurence-Moon syndrome (without polydactyly, i.e., without the appearance of supernumerary fingers or toes, and obesity, but with paraplegia … Amenorrhea: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by amenorrhea: Skin and subcutaneous (L00-L99). Xeroderma (dry skin). Musculoskeletal system and connective tissue (M00-M99). Osteoporosis (bone loss) Neoplasms – tumor diseases (C00-D48) Endometrial cancer (cancer of the uterus) – chronic anovulation (failure to ovulate) increases the long-term risk of endometrial … Amenorrhea: Complications
WHO classification of amenorrhea. WHO stage Definition Examples Endocrinological diagnostics I Hypogonadotropic normoprolactinemic ovarian failure = hypothalamic-hypogonadotropic (-hypophyseal hypofunction) Competitive sports, eating disorders (e.g., anorexia nervosa/anorexia nervosa), Kallmann syndrome (hypogonadotropic hypogonadism + anosmia/loss of sense of smell), Sheehan syndrome (loss of function of the anterior lobe of the pituitary gland, which usually occurs postpartum (after … Amenorrhea: Classification
General measures Limited alcohol consumption (max. 12 g alcohol per day). Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for the underweight. BMI ≥ 25 → participation in … Amenorrhea: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes [look for possible androgenization signs such as acne, hirsutism/male distribution pattern of terminal (long) hair] Abdomen Shape of the abdomen? Skin color? Skin texture? [Look … Amenorrhea: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Differential blood count HCG (human chorionic gonadotropin) determination – to rule out pregnancy. FSH (follicle-stimulating hormone). LH (luteinizing hormone) Prolactin TSH (thyroid-stimulating hormone) Testosterone 17-Beta-estradiol Laboratory parameters 2nd order – depending on the results of the history, physical examination, etc. – for differential diagnostic … Amenorrhea: Test and Diagnosis
Therapeutic target Normalization of the cycle interval Therapy recommendations Treatment depending on the causative disorder and dependence: On the prevention of hormone deficiency symptoms or hormone deficiency diseases. From the desire to have children From the desire for contraception (desire of contraception). Of cosmetic desires (acne, hirsutism / excessive hair growth with male distribution pattern). … Amenorrhea: Drug Therapy
Obligatory medical device diagnostics. Vaginal ultrasonography (ultrasound examination using an ultrasound probe inserted into the vagina (sheath)) – to evaluate the genital organs or to rule out PCO syndrome. Abdominal sonography (ultrasound examination of the abdominal organs) – mainly to assess the kidneys, adrenal glands and ovaries (ovaries). Optional medical device diagnostics – depending onthe … Amenorrhea: Diagnostic Tests
To prevent amenorrhea, attention must be paid to reducing individual risk factors. Behavioral risk factors Consumption of stimulants Alcohol Drug use Amphetamines (indirect sympathomimetic). Heroin LSD (lysergic acid diethylamide/lysergide) Physical activity Competitive sports Psycho-social situation Psychosocial stress Overweight (BMI ≥ 25; obesity). Other risk factors Lactation period (breastfeeding phase)
The following symptoms and complaints may indicate amenorrhea: Leading symptom Primary amenorrhea: absence of menarche (first menstrual period): Until after the age of 14 (in the absence of pubertal development) or. Until after the age of 16 (when pubertal development has already begun). Secondary amenorrhea: no menstrual bleeding for > 90 days with already established … Amenorrhea: Symptoms, Complaints, Signs
Pathogenesis (development of disease) Primary amenorrhea can be distinguished from secondary amenorrhea.Primary amenorrhea is usually caused by a developmental or hormonal disorder.Secondary amenorrhea is predominantly caused by hormonal disorders. Pregnancy and lactation amenorrhea are considered physiological conditions. Etiology (Causes) Biographic causes Genetic burden from parents, grandparents. Genetic diseases Adrenogenital syndrome (AGS) – autosomal recessive inherited … Amenorrhea: Causes
