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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 characteristicsAbsence of menses by age 14 without secondary sexual development,Absence of menses for 6 months in a previously menstruating fema

2、le,2,2006-11-15 七年制,Amenorrhea,Events of Puberty,Thelarche(breast development)Requires estrogenPubarche/adrenarche(pubic hair development)Requires androgensMenarcheRequires:GnRH from the hypothalamusFSH and LH from the pituitaryEstrogen and progesterone from the ovariesNormal outflow tract,3,2006-11

3、-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 amenorrheaPsychological stress5a-Reductase deficiencyAnorexia nervosa,weight loss Increased

4、 exercise levelsKallmann 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 amenorrheaGonadal dysgenesisTurner syndrome:low hair line,web nec

5、k,shield chest,and widely spaced nipples)Swyer syndrome resistant ovary syndromePremature 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 features of Turner Syndrome,12,

6、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(utero-vaginal agenesis),15%

7、of primary amenorrhea Normal secondary development&external female genitaliaNormal female range testosterone levelAbsent uterus and upper vagina&normal ovariesKaryotype 46-XX15-30%renal,skeletal and middle ear anomalies,15,2006-11-15 七年制,Amenorrhea,Androgen Insensitivity,Normal breasts but no sexual

8、 hairNormal looking female external genitaliaAbsent uterus and upper vaginaKaryotype 46,XYMale range testosterone levelTreatment:gonadectomy after puberty+HRT,16,2006-11-15 七年制,Amenorrhea,Diagnosis,History Physical examinationPhysical examination begins with vital signs,including height and weight,a

9、nd 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 test,-ve.est,progest.challenge test,FSH30-40,Normal FS

10、H,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 include:Dietary changes,including an increase in fat and ca

11、lories 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,