Amenorrhea, primary

Amenorrhea (primary Conjugated equine estrogen 0.625-1.25 mg by mouth daily Thromboembolism, breast... 

A. totalis 198 Alveolar ridges, broad 583 Ambiguous genitalia 552 Amenorrhea, primary 552 Amino aciduria 233, 362 Androgen... 

For most conditions associated with primary and secondary amenorrhea, estrogen (along with a progestin to minimize the risk of endometrial hyperplasia) is provided. 

Amenorrhea traditionally is described as either primary or secondary in nature. Primary amenorrhea is the absence of menses by age 16 in the presence of normal secondary sexual development or the absence of menses by age 14 in the absence of normal secondary sexual development. Secondary amenorrhea is the absence of menses for three cycles or 6 months in a previously menstruating woman. However, in clinical practice, there is a significant amount of overlap. The initial evaluation of amenorrhea is often the same regardless of age of onset, except in unusual clinical situations.1... 

Efficacy Normal breast development (especially primary amenorrhea in adolescents) preservation/improvement of BMD return of menses. 

Primary amenorrhea Absence of menses by age 16 in the presence of normal secondary sexual development or absence of menses by age 14 in the absence of normal secondary sexual development. 

In cases of secondary amenorrhea, symptoms may include hot flushes, night sweats, fatigue, and mood changes. In primary amenorrhea, incomplete development of secondary sex characteristics may occur. 

Uses Primary hypothalamic amenorrhea Action Stimulates pituitary release of LH FSH Dose 5 meg IV q90min x 21 d using pump kit Caution [B, M] T Levels w/ androgens, estrogens, progestins, glucocorticoids, spironolactone, levodopa ... 

Case (v) A 35-year-old female had primary infertility with secondary amenorrhea, ceasation of ovarian function and uterine fibroid tumour on the posterior wall at the junction of upper one-third and lower two-third of the uterus. Symptoms Amenorrhea for the last two years, obase, sweaty palms and soles, craving for eggs, irregular menstruation earlier. 

Zondek and 13-30 Cells (regular menstruation) 15-32 Cells (primary amenorrhea) 12-29 Cells (secondary amenorrhea) ... 

Generic Name Hydroxyprogesterone Trade Name(s) Hylutin, Prodrox, others Primary Indication(s) Amenorrhea, dysfunctional uterine bleeding... 

Cyclophosphamide and vincristine are examples of alkylating agents capable of inducing gonadal dysfunction. Premature menopause is a primary outcome of exposure to these agents. Amenorrhea and abnormal hormonal levels are characteristics of the ovarian dysfunction induced by cyclophosphamide. 

Anovulatory women with the following conditions may benefit from hMG primary amenorrhea,... 

Circulating iodoproteins in a nongoitrous adult with primary amenorrhea, body deformities, and normal levels of serum precipitable iodine and thyroidal I131 intake. Ibid., 17, 1141 (1957). With S. C. Werner and R. H. Mandl. 

Lauriola AL, Taugeriui A, Lodi A, Gamberini MR, Testa MR, Orziucolo C, De Sauctis V, Vullo C. Rachitic rosary iu a well chelated thalassaemic patient with primary amenorrhea (patient report). J Pediatr Endocrinol Metab 1998 ll(Suppl 3) 979-80. 

Primary and Secondary Amenorrhea and Functional Uterine Bleeding Caused by Insufficient Progesterone Production or Estrogen-Progesterone Imbalance. 

In a normal ovulatory menstrual cycle, menstruation occurs every 28 days on average. Normal women display considerable variation in cycle length that varies from 25 to 30 days." Amenorrhea, the absence of menstrual bleeding, is traditionally categorized as either primary (women who have never menstruated) or secondary (women in whom menstruation is present for a variable time and then ceases). Amenorrhea is a relatively common disorder, with an estimated prevalence of 5% in the general population and as high as 8.5% in an unselected adolescent postpubescent population. ... 

Primary amenorrhea (Box 53-2) is defined as a failure to establish spontaneous periodic menstruation by the age of 16 regardless of whether secondary sex characteristics have... 

A 17a-hydroxylase deficiency is a rare form of CAH that is associated with delayed puberty, primary amenorrhea, and hypertension. These patients have a 46 XX karyotype with elevated gonadotropins, low sex steroids, hypertension, and hypokalemia (see Chapter 51). ... 

Another rare cause of amenorrhea is the so-called resistant ovary syndrome. This primary hypogonadal condition is associated with increased concentrations of plasma FSH and LH, and ovaries that contain predominantly primordial follicles. It is thought to arise from a defect in FSH receptors. This disorder can be diagnosed only by examination of an ovarian biopsy specimen, which will exhibit functioning ovarian follicles despite the presence of amenorrhea. Ovulation can sometimes be induced in these patients with administration of high doses of gonadotropins. 

As discussed earlier, Kallmann s syndrome involves hypogonadotropic hypogonadism associated with anosmia or hyposraia and is caused by a defect in the formation and migration of GnRH neurons. Sexual infantilism is the prominent manifestation and primary amenorrhea is common. Finally, delayed pubertal development also should be considered. 

Tests for the Evaluation of Amenorrhea Evaluation of Primary Amenorrhea... 

Many causes of secondary amenorrhea have also caused primary dysfunction. These disorders are discussed in the following section. Often, delayed puberty is not caused by specific organic disease, but is simply an unusual outcome of the spectrum of maturation. 

Davajan V, Kletzlcy OA. Primary amenorrhea phenotypic female external genitalia. In MisheU DR, Davajan V, Lobo RA, eds. Infertility, contraception and reproductive endocrinology. 3rd ed. Boston Blackwell Scientific Publications, 1993 356-71. 

Premature ovarian failure may occur on the basis of ovarian follicle dysfunction or ovarian follicle depletion and may present as either primary amenorrhea (absence of menses in a girl who has reached the age of 16) or secondary amenorrhea (cessation of menses in a woman previously menstruating for 6 months or more). 

Primary amenorrhea Incomplete development of secondary sex characteristics... 

Premature ovarian failure is defined by the presence of at least 4 months of amenorrhea and at least two serum FSH concentrations measuring greater than 40 lU/L (obtained at least 1 month apart) in women younger than 40 years of age. A complete history should be taken regarding other factors that can affect ovarian function such as prior ovarian surgery, chemotherapy, radiation, and autoimmune disorders. In patients with primary amenorrhea, particular attention should be paid to breast and pubic hair development according to... 

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