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1、Dr.MohammedAbdallaObst.Gyn.SpecialistEgypt,DomiatG.HospitalHamoda1992@hotmail.comASSESSMENTOFACASEOFAMENORRHEAAMENORRHEAAmenorrheaistheabsenceorabnormalcessationofthemenses.Apatientisdiagnosedwithprimaryamenorrheaifshehasnotreachedmenarchebyage15.1Sh

2、emeetsthecriteriaforsecondaryamenorrheaifestablishedmenseshaveceasedforlongerthan6monthsEtiologyofAmenorrheaPrimaryGonadalfailure(43%)Congenitalabsenceofuterusandvagina(15%)Constitutionaldelay(14%)SecondaryChronicanovulation(39%)Hypothyroidism/hyperpr

3、olactinemia(20%)Weightloss/anorexia(16%)THEASSESSMENTPrimaryamenorrheavaginanoyescongenitaluterovaginalagenesisimperforatehymencompletetransversevaginalseptumPubichairEstrogenizedbreastshavedevelopedthe(MPA)challengeabnormalovariesabnormalhormonalstim

4、ulationofnormalovariesFSHLevelChromosomeAnalysisnonoyescompleteandrogeninsensitivitysyndrome(CAIS)+-highlowSecondaryAmenorrheaSecondaryamenorrheaistheabsenceofmenstrualperiodsfor6monthsinawomanwhohadpreviouslybeenregular,orfor12monthsinawomanwhohadirr

5、egularperiods.incidence1%ofwomenofreproductiveage.Themostcommoncauseofsecondaryamenorrheainreproductiveagewomenispregnancyandthisshouldalwaysbeexcludedbyphysicalexamandlaboratorytestingforthepregnancyhormone-HCG.HistoryAgoodhistorycanrevealtheetiologi

6、cdiagnosisinupto85%ofcasesofamenorrhea.Galactorrheahotflashes,breastatrophyanddecreasedlibidoCertainmedicationsAlargeamountofweightlossorgainAnorexianervosaCushing'sdisease andhypothyroidismSheehan'ssyndrome.Asherman'ssyndromeAmenorrheafollowingcervic

7、alconizationFollowingdiscontinuationoforalcontraceptionHistoryPhysicalexaminationSignsofandrogenexcessThebreastexammayrevealgalactorrheaEstrogendeficiencymaybesuggestedonpelvicexambyasmoothvaginathatlacksthenormalrugae(wrinkles)andadryendocervixwithno

8、mucouswhatthedoctorwilldonext?Ifthehistoryandphysicalexamaresuggestiveofacertainetiology:forthesakeofefficiencyandcost-effectiveness,theworkupcansometimesbemoredirected.(in85%ofcases.)Somepatientswillnotdemonstrateanyobviousetiologyfortheirame