Case 1 Patient: Woman, age 19 e Complaint: No menstruation by age 19 Present history: General feels good, but has no secondary sex changes and no periods. no cyclic abdominal pain Past history: Nothing special noted
Case 1 Patient: Woman, age 19 Complaint: No menstruation by age 19 Present history: General feels good, but has no secondary sex changes and no periods. No cyclic abdominal pain. Past history: Nothing special noted
Case 2 Patient: Woman age 30 Complaint: No menstruation; Hot and sweating a Present history: Normal menstrual cycle. IUD removal 8 month ago. Amount of bleeding in the following menstruation was markedly reduced and there was no bleeding for the second cycle. She was put on a sequential therapy with estrogens and progesterone, but no withdrawal bleeding was noted. Two months ago she started to feel hot and sweating in particular in the morning and the symptoms was getting worse Past history: Married at age 25. Pregnant 2 months after marriage, had an artificial abortion at 46 days. An IUd was inserted then
Case 2 Patient: Woman age 30 Complaint: No menstruation; Hot and sweating. Present history: Normal menstrual cycle. IUD removal 8 month ago. Amount of bleeding in the following menstruation was markedly reduced, and there was no bleeding for the second cycle. She was put on a sequential therapy with estrogens and progesterone, but no withdrawal bleeding was noted. Two months ago she started to feel hot and sweating in particular in the morning and the symptoms was getting worse. Past history: Married at age 25. Pregnant 2 months after marriage,had an artificial abortion at 46 days. An IUD was inserted then
Amenorrhea (闭经)
Amenorrhea (闭经）
Definitions Primary amenorrhea(原发闭经): . (1) No periods by age 16 (2) No periods by age 14 with no secondary sex changes (3)No periods by 2 years after the start of secondary sex changes Secondary amenorrhea(继发闭经) Absence of normal menstruation in a patient with previously established cycles. D)At any age when menses have ceased for more than 6 months or (2 ) longer than the total length of three previous menstrual cycles
Definitions Primary amenorrhea (原发闭经): (1) No periods by age 16 (2) No periods by age 14 with no secondary sex changes (3) No periods by 2 years after the start of secondary sex changes Secondary amenorrhea (继发闭经): Absence of normal menstruation in a patient with previously established cycles. (1) At any age when menses have ceased for more than 6 months or (2) longer than the total length of three previous menstrual cycles
Definitions Problems associated with amenorrhea 1)Infertility(due to anovulation) 2)Osteoporosis and atrophy of the reproductive tract(due to low level of estrogen) 3)Endometrial cancer (due to prolonged stimulation by estrogen) )Psychological problems in adolescents
1) Infertility (due to anovulation) 2) Osteoporosis and atrophy of the reproductive tract (due to low level of estrogen) 3) Endometrial cancer (due to prolonged stimulation by estrogen) 4) Psychological problems in adolescents Problems associated with amenorrhea Definitions
Primary amenorrhea Differentiation of the primitive gonads(原始性腺) starts at 6 weeks Y chromosome encodes the testis determining factor (TDF) formation of testis(睾丸) Mesonephric duct∧ Wolffian duct(中肾管)→male reproductive tract: vas deference(输精管, epididymis (附睾), ejaculatory duct(射精管) and seminal vesicle (精囊) Paramesonephric duct/Mullerian duct(副中肾管) fallopian tubes, uterus, vagina(upper 1/3)
Primary amenorrhea Differentiation of the primitive gonads (原始性腺) starts at 6 weeks. Y chromosome encodes the testis determining factor (TDF)→formation of testis (睾丸) Mesonephric duct/Wolffian duct (中肾管) → male reproductive tract: vas deference (输精管), epididymis (附睾), ejaculatory duct (射精管) and seminal vesicle (精囊) Paramesonephric duct/Mullerian duct (副中肾管) →fallopian tubes, uterus, vagina (upper 1/3)
未分化性腺 中肾小管 删中肾曾 中肾管 图3-2中肾管与副中肾管 巢 卵果固有韧带 果冠 卵巢 卵管 副中肾管 卵果冠黄营 中肾管 子宫圆带 子宫阴道 中肾腹股 一卵暴冠纵管 尿生殖窦 图3-3女性内生殖器的形成
Primary amenorrhea Etiology Genetic causes Developmental abnormality 1. Presence of secondary sex characteristics
Primary amenorrhea Etiology • Genetic causes • Developmental abnormality 1. Presence of secondary sex characteristics
Primary amenorrhea Etiology Mullerian agenesis syndrome (米勒管发育不全综合征) Mayer-Rokitansky-Kuster-Hauser syndrome (1) Karyotype: 46, XX (2)Normal ovary, fallopian tubes, absence of uterus and vagina (3)Normal FSH (4) Normal secondary sex characteristics
Etiology 1) Mullerian agenesis syndrome (米勒管发育不全综合征) Mayer-Rokitansky-Kuster-Hauser syndrome (1) Karyotype: 46, XX (2) Normal ovary, fallopian tubes, absence of uterus and vagina (3) Normal FSH (4) Normal secondary sex characteristics Primary amenorrhea