Learning Objectives
•Definition
•Classifications
•Aetiology
•Evaluation a case of amenorrhea
•Treatment
•Normal Sexual Differentiation has 3 stages:
1.Establishment of chromosomal sex
2.Development of the undifferentiated gonads
3.Differentiation of internal ducts & genitalia
Defining Sex and Gender
Gender identity (Psychological sex)
Inner sense of owns maleness / femaleness.
Sex of rearing
Sexual identity (Organic sex)
The biologic sexual differentiation
Chromosomal sex
Gonadal sex
Internal genital sex
External genital sex
Hormonal sex
Summary of Normal Sex Differentiation
Genetic sex is determined at fertilization.
Testes develop in XY fetus, ovaries develop in XX fetus.
XY fetus produces MIS and androgens and XX fetus does not.
XY fetus develops Wolffian ducts and XX fetus develops Mullerian ducts.
XY fetus masculinizes the female genitalia to make it male and the XX fetus retains female genitalia.
AMENORRHOEA
AN APPROACH FOR DIAGNOSIS
• HISTORY
• PHYSICAL EXAMINATION
• ULTRASOUND EXAMINATION
Exclude Pregnancy
Exclude Cryptomenorrhea
Summary
•Although the work-up of amenorrhea may seem to be complex, a carefully conducted physical examination with the history, and Looking to the patient as a bioassay for endocrine abnormalities, should permit the clinician to narrow the diagnostic possibilities and an accurate diagnosis can be obtained quickly.
•Management aims at restoring ovulatory cycles if possible, replacing estrogen when deficient and Progestogegen to protect endometrium from unopposed estrogen.
• Frequent re-evaluation and reassurance of the patient.