Amenorrhea: Pathology Review
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Amenorrhea: Pathology Review
Pathology
Male and female reproductive system disorders
Precocious puberty
Delayed puberty
Klinefelter syndrome
Turner syndrome
Androgen insensitivity syndrome
5-alpha-reductase deficiency
Kallmann syndrome
Male reproductive system disorders
Hypospadias and epispadias
Bladder exstrophy
Priapism
Penile cancer
Prostatitis
Benign prostatic hyperplasia
Prostate cancer
Cryptorchidism
Inguinal hernia
Varicocele
Epididymitis
Orchitis
Testicular torsion
Testicular cancer
Erectile dysfunction
Male hypoactive sexual desire disorder
Female reproductive system disorders
Amenorrhea
Ovarian cyst
Premature ovarian failure
Polycystic ovary syndrome
Ovarian torsion
Krukenberg tumor
Sex cord-gonadal stromal tumor
Surface epithelial-stromal tumor
Germ cell ovarian tumor
Uterine fibroid
Endometriosis
Endometritis
Endometrial hyperplasia
Endometrial cancer
Choriocarcinoma
Cervical cancer
Pelvic inflammatory disease
Urethritis
Female sexual interest and arousal disorder
Orgasmic dysfunction
Genito-pelvic pain and penetration disorder
Mastitis
Fibrocystic breast changes
Intraductal papilloma
Phyllodes tumor
Paget disease of the breast
Breast cancer
Hyperemesis gravidarum
Gestational hypertension
Preeclampsia & eclampsia
Gestational diabetes
Cervical incompetence
Placenta previa
Placenta accreta
Placental abruption
Oligohydramnios
Polyhydramnios
Potter sequence
Intrauterine growth restriction
Preterm labor
Postpartum hemorrhage
Chorioamnionitis
Congenital toxoplasmosis
Congenital cytomegalovirus (NORD)
Congenital syphilis
Neonatal conjunctivitis
Neonatal herpes simplex
Congenital rubella syndrome
Neonatal sepsis
Neonatal meningitis
Miscarriage
Gestational trophoblastic disease
Ectopic pregnancy
Fetal hydantoin syndrome
Fetal alcohol syndrome
Reproductive system pathology review
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
Assessments
Amenorrhea: Pathology Review
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Transcript
Content Reviewers
Antonella Melani, MDContributors
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.
Summary
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.
Sources
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Robbins Basic Pathology" Elsevier (2017)
- "Diagnostic Immunohistochemistry" Elsevier (2021)
- "Bates' Guide to Physical Examination and History Taking" LWW (2017)
- "Atlas of Emergency Medicine" Wolters Kluwer (2015)
- "Differential regulation of metabolic, neuroendocrine, and immune function by leptin in humans" Proceedings of the National Academy of Sciences (2006)
- "Menstrual Cycles: Fatness as a Determinant of Minimum Weight for Height Necessary for Their Maintenance or Onset" Science (1974)
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