Medicine an Surgery notes

Apr 24th, 2015
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AMENORRHEA--Primary amenorrhea is defined as the failure of menses to occur by age 16 years. --Secondary amenorrhea is defined as the cessation of menses once they have begun. --Oligomenorrhea is defined as menses occurring at intervals longer than 35 days.--Women with amenorrhea who do have evidence of androgen excess, such as hirsutism, virilization, or sexual ambiguity, should be evaluated differently from women with amenorrhea alone.Pathophysiology: Regular and predictable menstrual cycles occur if the ovarian hormones estradiol and progesterone are secreted in an orderly fashion in response to stimulation by the hypothalamus and pituitary. --Circulating estradiol stimulates growth of the endometrium. --Progesterone, produced by the corpus luteum formed after ovulation, transforms proliferating endometrium into secretory endometrium. --If pregnancy does not occur, this secretory endometrium breaks down and sheds during the ensuing menstrual period. --Amenorrhea occurs if the hypothalamus and pituitary fail to provide appropriate gonadotropin stimulation to the ovary, resulting in inadequate production of estradiol or in failure of ovulation and progesterone production. --Amenorrhea can also occur if the ovaries fail to produce adequate amounts of estradiol despite normal and appropriate gonadotropin stimulation by the hypothalamus and pituitary.-- In some cases, the hypothalamus, pituitary, and ovaries all may be functioning normally, yet amenorrhea occurs bec

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