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AMENORRHEA

Preceptor
Dr. Ni Made Desy S., MM. Sp.OG
Editor
Jasmine Nazila 1010221067
Chief complain
Admitted to the hospital with 3 months without menstruation
Present medical history
She admitted to the hospital because she had 3 months without menstruation. The previous
menstrual cycle is irregular. Due to these complaints, she has already done a pregnancy test
pack and the result is negative. She said that she never had sexual intercourse before. LMP
30/06/2012 . 3 years ago shes also have the same experience and after get the medication she
had menstuation.
Previous medical history and family medical history
HT (-), DM (-), cardiac disease (-), allergy (-), asthma (-)
Menstrual history, obstetric history, contraception
Menstrual history : menarche 12 yo, irregular, 5-7 days, pain (-)
Obst history : (-)
Marital history: (-)
Contraception : (-)
Physical examination
CM, BP 90/60 mmHg, HR 82x, RR 18x/mnt, S 36.6
Gen stat : wnl
Gyn St :
I : v/u (N), bleeding (-)
Rectal Toucher : Corps uteri (N), soft parametrium, adnexal mass (-), pain (-)

Pregnancy test pack (11/09/12)
-Negative
Diagnosis
Secondary amenorrhea et causa
imbalanced hormone
Management
Ultrasonography (USG)
Amenorrhea
Ms. DS /22 yo
RM : 87.50.81
Secondary amenorrhea et causa susp. Imbalanced hormone

BACKGROUND


Yes physiological from the reproductive
system hormone not fertilized ovum


Menstruation
primary 0,1-2,5%
No Amenorea
secondary 1-5%


1. Wiknjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu Kandungan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 2008: 203-223
2. Cunningham, McDonald, Gant. Obstetri Williams. Jakarta. EGC. 2005

DEFINITION
The absence of a menstrual period in a woman of
reproductive age at least 3 months.
Primary
No menarche by age 16 years with signs of
pubertal development.
No onset of pubertal development by age 14 years.
Secondary
Absence of menstruation for 3 or more months in
previously menstruating women of reproductive
age.
1.Wiknjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu Kandungan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo, 2008: 203-223
3. http://www.klikdokter.com/kesehatankewanitaan/read/2010/07/05/4/amenorea
CLASSIFICATION


- Compartement I : anatomic abnormalities of the
reproductive tract
- Compartement II : ovarian disorders
- Compartement III : pituitary anterior disorders
- Compartement IV : central nervous system disorders
(hipothalamus)




1. Wiknjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu Kandungan. Jakarta: Yayasan Bina Pustaka Sarwono Prawirohardjo,
2008: 203-223
9. Brewer JI, Decosta EJ. Textbook of Gynecology. 4
th
edition. Baltimore: Williams & Wilkins, 1967: 101-136. Diunduh dari :
http://www.forumotionkesehatan.com


Environment

compartement IV




compartement III GnRH




compartement II FSH LH



compartement I
Estrogen Progesteron
Central nervous system
Median eminence
Uterus
Anterior Pituitary
Ovarium
Psychological stress
5a-Reductase deficiency
Anorexia nervosa, weight loss
Increased exercise levels
drug-induced amenorrhea
Space-occupying lesion of CNS
hypothalamic
amenorrhea
tumor
Empty sella syndrome
Sheehan syndrome
pituitary
amenorrhea
Gonadal dysgenesis
Turner syndrome: low hair line, web neck, shield
chest, and widely spaced nipples
resistant ovary syndrome
Premature ovarian failure
ovarian
amenorrhea
Etiology
Absence of uterus
Asherman syndrome
uterine
amenorrhea
Imperforate Hymen
anatomic
abnormalities of
the reproductive
tract
DIAGNOSIS

Physical Examination
Investigation (laboratory
exam)
Anamnese
PUBERTAL DEVELOPMENT IN NORMAL WOMEN
DESCRIBED BY TANNER STAGE ARE
DIAGNOSIS
Anamnesis:
primary or secondary amenorrhea.
Relationship with emotional disorders, pregnancy, acute /
chronic
There are symptoms of metabolic disease
Growth of secondary sex
menstrual history
Past medical history and family history of disease
Physical Examination:
vital signs
TB-BB
Secondary sexual development
DIAGNOSIS
Photo Roentgen thoracic tuberculosis Pulmonum
vaginal cytology for the presence of estrogen
eye examination pituitary tumor.
uterine scrapings for the state of the endometrium, endometritis
tuberculosis
T3 and T4 examination to determine the function of thyroid
gland.
Additional
Examination
laparoscopy for severe hypoplasia uteri, uterine aplasia, ovarian
dysgenesis, ovarian tumors, polycystic ovary (Stein-Leventhal
Syndrome)
Examination of sex chromatin
Making kariogram by culturing the cells in order to learn things
on the chromosome.
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
FSH>30-40
Normal FSH
HSG OR hysteroscopy
asherman
2wk
FSH norm.
repeat
Repeat+serum
,est.level
PROF
hypothalamic-
pituitary failure
anovulation
TREATMENT
Treatment varies depending upon the causes of the amenorrhea.
Treatment options include:
Dietary changes, including an increase in fat and calories 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

DAFTAR PUSTAKA
1. Wiknjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu Kandungan. Jakarta: Yayasan Bina Pustaka
Sarwono Prawirohardjo, 2008: 203-223
2. Cunningham, McDonald, Gant. Obstetri Williams. Jakarta. EGC. 2005
3. http://www.klikdokter.com/kesehatankewanitaan/read/2010/07/05/4/amenorea Dikases tanggal 17 Juli
2011.
4. Wiknjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka
Sarwono Prawirohardjo, 2008: 203-223
5. Ilmu Kebidanan. Fakultas Kedokteran Universitas Indonesia. Jakarta. EGC. 20
6. Baziad, Ali. Endokrinologi Ginekologi. FKUI. Jakarta. 2008
7. Rebar RW, Connolly HV. Clinical features of young women with hypergonadotropic amenorrhea. Fertil
Steril 1990, 53: 804-810
8. Scherzer WJ, McClamrock H. Amenorrhea. In: Berek JS, Adashi EY, Hillard PA. Novaks gynecology.
12
th
edition. Baltimore: Williams & Wilkins, 1996: 820-832. Diunduh dari : http://www.klik
dokter.com/amenoreatatalaksana diakses tanggal 18 Juli 2011.
9. Brewer JI, Decosta EJ. Textbook of Gynecology. 4
th
edition. Baltimore: Williams & Wilkins, 1967: 101-
136. Diunduh dari : http://www.forumotionkesehatan.com diakses tanggal 16 Juli 2011.
10. Yen SSC. Chronic anovulation caused by peripheral endocrine disorders. In: Yen SSC, Jaffe RB.
Reproductive Endocrinology. 3
rd
edition. Philadelphia: WB Saunders Company, 1991: 577-673. Diunduh
dari : http://www.kesehatanwanitadewasa.com Diakses tanggal 16 Juli 2011.
11. Andon Hestiantoro, dr. SpOG, KFER. Divisi Imunoendokrinologi Reproduksi. Departemen Obstetri dan
Ginekologi. Fakultas Kedokteran Universitas Indonesia, Jakarta, 2010. Diunduh dari :
http://www.botefilia.com/index.php/archives/2010. diakses tanggal 18 Juli 2011.