Primary and secondary amenorrhea

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Aménorrhées primaire et secondaireAmenorrhea PRIMARY :

Primary amenorrhea is defined as a lack of rules in the girl after age 16 years with or without pubertal development. The existence of amenorrhea indicates a breach of the hypothalamic-pituitary-ovarian axis or an anatomical abnormality of the genitals. A progestagen treatment without prior assessment is therefore illegitimate. It was after the search for a cause that will be offered an etiological treatment.

Clinique :

The questioning look :

- in the family, history of hypogonadism (genetic cause) ;

- or not a nutritional deficiency related to chronic disease.

Clinical examination appreciate :

- pubertal development (assessment of estradiol secretion) ;

- a small, a malformation syndrome, anosmia ;

- gynecological examination, often difficult, must be careful, Looking for an ambiguous genitalia, an imperforate hymen.

Additional tests :

- The dosage of pituitary hormones (FSH, LH), of 17beta-estradiol appreciated axis hypophysogonadique, thereby determining, the origin of high or low hormone deficiency or absence of estrogen deficiency.

- A pelvic ultrasound can confirm the presence or absence of uterus, of the 2 ovary, can reveal the existence of male gonads in the inguinal canals.

- A radiograph of the left hand will determine bone age.

- The karyotype, achieved only if the cause of hypogonadism is peripheral, will highlight gonadal dysgenesis.

ASECONDARY menorrhea :

Secondary amenorrhea, unlike primary amenorrhea, are most often the result of an acquired pathology.

The first reflex to secondary amenorrhea is to eliminate pregnancy, whatever the circumstances, by assaying the b-HCG.

Clinique :

The questioning look :

- a drug responsibility : antidopaminergic drugs, progestin, corticosteroids, radiotherapy, chemotherapy ;

- endocrine disease or chronic condition that can sound an alarm in the gonadotropic axis ;

- flushing of early menopause ;

- cyclic pelvic pain (because uterine : curettage, DEFINITELY, IVG, etc.).

Clinical examination appreciate the weight, size, gynecological examination the state of the mucosa and mucus. he noted :

- signs of hyperandrogenism : seborrhea, acne, hyperpilosité ;

- spontaneous or induced galactorrhea, bilateral, multipore, lactescentes, so endocrine.

Additional tests :

Two kinds of tests are essential and will allow the conduct of the etiologic diagnosis :

- Organics : FSH, LH, 17b-estradiol, prolactin, D4-androstenedione, testosterone ;

- Pelvic ultrasound necessary transvaginal.

A test progestin should be performed to assess the ovarian estradiol secretion : administration of a progestin while 10 days : said the test is positive if the rules occur in 5 days after stopping progestin. This test is positive if the impregnation estrogen is sufficient, negative when estrogen deficiency is severe.

etiological diagnosis :

The conduct of the etiologic diagnosis of secondary amenorrhea may well be outlined

Hormonal assays are designed to identify the main causes of secondary amenorrhea.

- In the first place, the hyperprolactinemia  : be aware checked by a prolactin assay pooled (isolated high dosage with no meaning, especially if moderate elevation). Hyperprolactinemia may indicate a prolactin adenoma, but it is important, before looking for a pituitary adenoma by imaging, eliminate hyperprolactinemia iatrogenic.

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