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Androgen insensitivity syndrome
Hypospadias and epispadias
Benign prostatic hyperplasia
Male hypoactive sexual desire disorder
Premature ovarian failure
Polycystic ovary syndrome
Sex cord-gonadal stromal tumor
Surface epithelial-stromal tumor
Germ cell ovarian tumor
Pelvic inflammatory disease
Female sexual interest and arousal disorder
Genito-pelvic pain and penetration disorder
Fibrocystic breast changes
Paget disease of the breast
Preeclampsia & eclampsia
Intrauterine growth restriction
Congenital cytomegalovirus (NORD)
Neonatal herpes simplex
Congenital rubella syndrome
Gestational trophoblastic disease
Fetal hydantoin syndrome
Fetal alcohol syndrome
Disorders of sex chromosomes: Pathology review
Prostate disorders and cancer: Pathology review
Testicular tumors: Pathology review
Uterine disorders: Pathology review
Ovarian cysts and tumors: Pathology review
Cervical cancer: Pathology review
Vaginal and vulvar disorders: Pathology review
Benign breast conditions: Pathology review
Breast cancer: Pathology review
Complications during pregnancy: Pathology review
Congenital TORCH infections: Pathology review
Disorders of sexual development and sex hormones: Pathology review
Amenorrhea: Pathology Review
Testicular and scrotal conditions: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
HIV and AIDS: Pathology review
Penile conditions: Pathology review
Amenorrhea: Pathology Review
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Sam Gillespie, BSc
Jung Hee Lee, MScBMC
Two people come to the clinic one day. First you see Ana, a 17 year old teenage girl. Ana comes with her mother, who’s worried because Ana hasn’t had her first period yet.
Upon physical examination, you notice that Ana is quite short for her age. In addition, she has a wide neck, broad chest, and poorly developed breasts with widely spaced nipples. You decide to perform a blood test, which reveals low estrogen levels and high FSH and LH.
Next, comes María, a 25 year old female who’s concerned because she hasn’t had her period for nine months now.
She’s sexually active, so the first thing you do is ask for a pregnancy test, which comes up negative.
When asked about physical activities, she refers to going for a 2-hour run every single day, plus swimming and then tennis on weekdays.
Regarding her diet, she’s very strict when it comes to avoiding fatty foods. On physical examination, you realize that María is underweight, and a blood test reveals low levels of estrogen, LH, and FSH.
Okay, now both Ana and María have amenorrhea, which is generally defined as the absence of menstruation in females of reproductive age.
Now, for menstruation to happen, an individual must have a regular female reproductive anatomy and sexual development, which is normally under control of the hypothalamic-pituitary-gonadal axis.
First, the hypothalamus secretes gonadotropin-releasing hormone, or GnRH for short, which goes to the anterior pituitary to stimulate the release of gonadotropic hormones, which are luteinizing hormone or LH, and follicle-stimulating hormone or FSH.
LH and FSH then stimulate the gonads to produce sex hormones; in females, LH and FSH stimulate the ovaries to secrete estrogen and progesterone, which are responsible for the female primary sexual characteristics.
These are the changes necessary for reproduction, including menstruation, ovulation, and uterine development.
Amenorrhea is the absence of menstrual periods in a woman of reproductive age. There are two types of amenorrhea: primary and secondary. Primary amenorrhea is defined as the failure to achieve menarche by age 16 in the absence of any secondary sexual characteristics, or by 14 if there are secondary sexual characteristics present. Secondary amenorrhea is defined as a cessation of menses for 3 months in a woman with previously established normal menstrual cycles.
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