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1、1,2006-11-15 七年制,Amenorrhea,Amenorrhea,Amenorrhea is the absence of menstruation. Primary Secondary,Absence of menses by age 16 with normal secondary sexual characteristics Absence of menses by age 14 without secondary sexual development,Absence of menses for 6 months in a previously menstruating fe
2、male,2,2006-11-15 七年制,Amenorrhea,Events of Puberty,Thelarche (breast development) Requires estrogen Pubarche/adrenarche (pubic hair development) Requires androgens Menarche Requires: GnRH from the hypothalamus FSH and LH from the pituitary Estrogen and progesterone from the ovaries Normal outflow tr
3、act,3,2006-11-15 七年制,Amenorrhea,4,2006-11-15 七年制,Amenorrhea,Classification of amenorrhea,hypothalamic amenorrhea pituitary amenorrhea ovarian amenorrhea uterine amenorrhea,5,2006-11-15 七年制,Amenorrhea,Etiology,hypothalamic amenorrhea Psychological stress 5a-Reductase deficiency Anorexia nervosa, weig
4、ht loss Increased exercise levels Kallmann syndrome drug-induced amenorrhea Space-occupying lesion of CNS,6,2006-11-15 七年制,Amenorrhea,Etiology,pituitary amenorrhea tumor Empty sella syndrome Sheehan syndrome,7,2006-11-15 七年制,Amenorrhea,Etiology,ovarian amenorrhea Gonadal dysgenesis Turner syndrome:
5、low hair line, web neck, shield chest, and widely spaced nipples) Swyer syndrome resistant ovary syndrome Premature ovarian failure,8,2006-11-15 七年制,Amenorrhea,Tunner staging,9,2006-11-15 七年制,Amenorrhea,Acanthosis nigrans,10,2006-11-15 七年制,Amenorrhea,Striae,11,2006-11-15 七年制,Amenorrhea,Typical featu
6、res of Turner Syndrome,12,2006-11-15 七年制,Amenorrhea,Etiology,uterine amenorrhea Absence of uterus Asherman syndrome anatomic abnormalities of the reproductive tract Imperforate Hymen,13,2006-11-15 七年制,Amenorrhea,Imperforate Hymen,14,2006-11-15 七年制,Amenorrhea,Mayer-Rokitansky-Kuster-Hauser Syndrome (
7、utero-vaginal agenesis),15% of primary amenorrhea Normal secondary development & external female genitalia Normal female range testosterone level Absent uterus and upper vagina & normal ovaries Karyotype 46-XX 15-30% renal, skeletal and middle ear anomalies,15,2006-11-15 七年制,Amenorrhea,Androgen Inse
8、nsitivity,Normal breasts but no sexual hair Normal looking female external genitalia Absent uterus and upper vagina Karyotype 46, XY Male range testosterone level Treatment : gonadectomy after puberty + HRT,16,2006-11-15 七年制,Amenorrhea,Diagnosis,History Physical examination Physical examination begi
9、ns with vital signs, including height and weight, and with sexual maturity ratings Laboratory evaluation,17,2006-11-15 七年制,Amenorrhea,VE- preg test,TSH ,PROLACTIN, Prog.challenge test,withdrawal bleeding,without withdrawal bleeding,hypoestrogenic,compromised outflow tract.,+ve.est,progest.challenge
10、test,-ve.est,progest .challenge test,FSH30-40,Normal FSH,HSG OR hysteroscopy asherman,2wk,FSH norm.,repeat,Repeat+serum ,est.level,PROF,hypothalamic-pituitary failure,anovulation,18,2006-11-15 七年制,Amenorrhea,Treatment,treatment varies depending upon the causes of the amenorrhea. Treatment options in
11、clude: Dietary changes, including an increase in fat and calories in order to stimulate estrogen production. Counseling for eating disorders. Using stress reduction techniques to help regulate the period. Hormonal supplements, like the birth control pill or patch, or hormone replacement therapy. Surgery to remove cysts, fibroids or tumors,DI WEN M.D., Ph.D. Professor & Chairman Department of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine,Thanks for Your Attention,