4 AMENORRHEA, SECONDARY General Discussion Secondary amenorrhea is the absence of menses for 3 months in women with previously normal menstruation or for 9 months in women with previous oligomenorrhea. Secondary amenorrhea is more common than primary amenorrhea. The most common cause of secondary amenorrhea is pregnancy. In addition to pregnancy, thyroid disease and hyperprolactinemia are also common causes of secondary amenorrhea. Once pregnancy, thyroid disease, and hyperprolactinemia are ruled out as potential causes, the remaining causes of secondary amenorrhea are classified as eugonadotropic amenorrhea, hypogonadotropic hypogonadism, and hypergonadotropic hypogonadism. Outflow tract obstruction and hyperandrogenic chronic anovulation are two common causes of eugonadotropic amenorrhea. Polycystic ovary syndrome (PCOS) is the most common cause of hyperandrogenic chronic anovulation. Clinically, it is helpful to separate patients who have secondary amenorrhea into those with and without hirsutism or signs of androgen excess. This can be done by history and physical examination as well as by laboratory studies. Physical examination may reveal hirsutism, acanthosis nigricans, acne, or clitoromegaly. Medications Associated with Amenorrhea Butyrophenones Contraceptive medications Divalproex Domperidone Haloperidol H2 blockers Methyldopa Metoclopramide Opiates Phenothiazine Psychotropic medications Reserpine Risperdone Sulpiride Verapamil Causes of Secondary Amenorrhea Eugonadism • Acromegaly • Androgen-secreting tumor • Asherman’s syndrome • Cervical stenosis • Congenital adrenal hyperplasia • Cushing’s disease • Exogenous androgens (anabolic steroids) • Hyperprolactinemia • Ovarian stromal hypertrophy • Polycystic ovary syndrome • Pregnancy • Thyroid disease Hypergonadotropic hypogonadism • Postmenopausal ovarian failure • Premature ovarian failure Hypogonadotropic hypogonadism • Anorexia nervosa • Bulimia nervosa • Celiac disease • Central nervous system tumor • Chronic liver disease Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on AMENORRHEA, SECONDARY Full access? Get Clinical Tree
4 AMENORRHEA, SECONDARY General Discussion Secondary amenorrhea is the absence of menses for 3 months in women with previously normal menstruation or for 9 months in women with previous oligomenorrhea. Secondary amenorrhea is more common than primary amenorrhea. The most common cause of secondary amenorrhea is pregnancy. In addition to pregnancy, thyroid disease and hyperprolactinemia are also common causes of secondary amenorrhea. Once pregnancy, thyroid disease, and hyperprolactinemia are ruled out as potential causes, the remaining causes of secondary amenorrhea are classified as eugonadotropic amenorrhea, hypogonadotropic hypogonadism, and hypergonadotropic hypogonadism. Outflow tract obstruction and hyperandrogenic chronic anovulation are two common causes of eugonadotropic amenorrhea. Polycystic ovary syndrome (PCOS) is the most common cause of hyperandrogenic chronic anovulation. Clinically, it is helpful to separate patients who have secondary amenorrhea into those with and without hirsutism or signs of androgen excess. This can be done by history and physical examination as well as by laboratory studies. Physical examination may reveal hirsutism, acanthosis nigricans, acne, or clitoromegaly. Medications Associated with Amenorrhea Butyrophenones Contraceptive medications Divalproex Domperidone Haloperidol H2 blockers Methyldopa Metoclopramide Opiates Phenothiazine Psychotropic medications Reserpine Risperdone Sulpiride Verapamil Causes of Secondary Amenorrhea Eugonadism • Acromegaly • Androgen-secreting tumor • Asherman’s syndrome • Cervical stenosis • Congenital adrenal hyperplasia • Cushing’s disease • Exogenous androgens (anabolic steroids) • Hyperprolactinemia • Ovarian stromal hypertrophy • Polycystic ovary syndrome • Pregnancy • Thyroid disease Hypergonadotropic hypogonadism • Postmenopausal ovarian failure • Premature ovarian failure Hypogonadotropic hypogonadism • Anorexia nervosa • Bulimia nervosa • Celiac disease • Central nervous system tumor • Chronic liver disease Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA GYNECOMASTIA INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on AMENORRHEA, SECONDARY Full access? Get Clinical Tree
