CASE REPORT

SECONDARY AMENORRHEA

Supervised by:

Ismu Setyo Djatmiko, dr., Sp.OG

Presented by:

Ikrom Mullah

(2011730041)

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

MEDICINE FACULTY OF MUHAMMADIYAH JAKARTA

UNIVERSITY

RSUD SYAMSUDIN SH SUKABUMI

2017
 CHAPTER I
INTRODUCTION

Menstruation is a regular cycle of sloughing of the uterine lining as a result

of the interaction of hormones produced by the hypothalamus, pituitary and ovaries.
The hypothalamus, pituitary and ovaries form HPO axis, the hormonal regulation and
reaction to feedback.

The hypothalamus, located in the central nervous system, release of

gonadotropin-releasing hormone (GnRH) continuously, which is transported to the
anterior pituitary, where it binds to the GnRH receptor to stimulate gonadotropin. In
response to stimulation by GnRH, these cells secrete gonadotropin follicle-stimulating
hormone (FSH) and luteinizing hormone (LH). Furthermore, these hormones
stimulate the ovaries to synthesize and secrete steroid hormones. The release of
hormones through the axis (HPO) hypothalamic-pituitary-ovarian negative feedback
regulated by steroid hormones in the anterior pituitary gonadotropin and direct
inhibition at the level of the hypothalamus. Stimulation and inhibition of negative
completes the path between the hypothalamus, pituitary and ovaries. Any disruption
of this axis can lead to amenorrhea.

Amenorrhea occurs if the hypothalamus and pituitary failure to provide

gonadotropin stimulation of the ovary, so that estradiol production is inadequate and
there is a failure or a failure of ovulation and progesterone production. Amenorrhea
may also occur if the ovaries fail to produce a sufficient amount of estradiol despite
normal gonadotropin stimulation by the hypothalamus and pituitary. In some cases,
the hypothalamus, pituitary and ovaries all be functioning normally, but amenorrhea
may occur due to uterine abnormality like adhesion in the endometrial cavity, a defect
of the cervix, uterine septum, and imperforate hymen.

Secondary amenorrhea is a woman of reproductive age who have had

menstrual periods but stopped three months in a row. The reason according to the
physiology of menstruation, then there are four compartments with disorders resulting
in amenorrhea
 CHAPTER II
CASE REPORT

Patients Identity
Name : Mrs. H
Age : 30 year-old
Nationality : Indonesian
Address : Sagaranten
Marital status : Married
Occupation : Housewife
Religion : Moslem
Date of admission : March 15th, 2017
Date of examination : March 15th, 2017

History Taking
Chief Complaint
Patient came to Polyclinic with complaint no menses since 3 months ago.

History of Present Illness

Patient came to the RSUD R. Syamsudin, SHs obstetrician &
gynecologist polyclinic, with complaint no menses since 3 months ago.
Previous patient regular periods every month since age 12 th with long period 7
days and felt pain during menstruation. Patient do not complain of symptoms
of nausea and vomiting in the morning, the breast feels tight, rapid fatigue and
frequent urination. Patient were not breastfeeding. Patient did not do a
pregnancy test for 3 months. Patients admitted to taking the pills KB in 2011.
Patient were also admitted using the KB injections in 2015. The patient denied
any vaginal discharge, pain during having sex, and also urinary and defecating
problems. She denied any other complaints, such as fever, dyspnea, and
others.

History of Past Illnesses

History of chronic hypertension : denied
History of kidney disease : denied
History of diabetes mellitus : denied
History of auto immune disease : denied
History of asthma : denied
History of allergy : denied
History of surgery : denied
History of cancer : denied
Familial History
History of hypertension : denied
History of kidney disease : denied
History of diabetes mellitus : denied
History of auto immune disease : denied
History of cancer : denied
 Menstruation History
Menarche : 12 years old
Menstrual cycle :regularly every 28-30 days, 7 days
duration and with history of
pain during menstruation
Amount of menstrual blood : 2-3 normal pads / day ( 60 cc )
LMP : 3 months ago

Contraception History
History of using contraception pills for 7 years in 2011.
History of using contraception hormone for 1 years in 2015.

Marital History
Married once, she has been married for 15 years

Obstetric History
Birth
No Date Gestational Age Labor History Sex
Weight
1. 2004 Aterm Vaginal delivery Boy 3000 g
2. 2014 Aterm Vaginal delivery Girl 2800 g

Physical Examination
General condition : mildly ill appearance
Consciousness : compos mentis
Blood pressure : 120/80 mmHg
Heart rate : 88 bpm
Respiratory rate : 20x/minute
Temperature : 37C
Weight : 50 kg
Height : 155 cm
BMI : 20,83 kg/m2

General Examination
Eyes : anemic conjunctiva -/-, icteric sclera -/-
Mouth : wet oral mucosa membrane
Heart : regular 1st and 2nd heart sounds, murmur -, gallop -
Lung
Inspection : symmetric chest expansion in breathing
Percussion : resonant on both lungs
Auscultation : vesicular breath sounds +/+, rhonchi -/-, wheezing -/-
Abdomen
Inspection : Flat, mass (-)
Palpation : mass (-), tenderness (+)
Auscultation : bowel sound (+)
Extremities : warm, edema -/-/-/-, CRT < 2 seconds
Gynecologic Examination
LMP : 3 months ago
Fundal height : difficult to examined
Inspection : vulvovagina within normal limit, blood (-), vaginal discharge
(-)
Inspeculo : blood -, erotion -, stoll cell -, tissue -, vaginal discharge -
Vaginal toucher : cervical motion tenderness -, felt mass at the right adnexa
with pain (-), felt mass at the left adnexa with pain (-)

Laboratory (March 15th 2017)

Types Results Units Normal Value
Urine
BhCg Urine Negative (-)

USG examination (March 15th 2017)

 Uterus : no mass, no gravid, within normal limit

Working Diagnosis
Mrs. H , 30 years old, P2A0, with Secondary Amenorrhea

Management
Primolut N 3 x 1 tab
Prognosis
Quo ad vitam : ad bonam
Quo ad functionam : dubia ad bonam
Quo ad sanationam : dubia ad bonam