Page 1 of 1: 25 yo woman w 7 mos amenorrhea.....

Kai1111 · Credits: 2036 My Scrapbook

The author states that the hx was neg, preg test neg....give 3 dxs and 4 investigations.... wish we had a more detailed hx....curious to know your thoughts....

Dxs: If no exercise induced/anorexic/stress amenorrhea; no galactorrhea, nor hirsutism/acne......(neg hx)
1. r/o PCO
2. r/o hypothal dysfunction
3. r/o Ashermann's Syndrm

Investigations:
1. FSH
2. TSH
3. progesterone challenge
4. Pelvic sono

any other thoughts?

tahir2008 · Credits: 530 My Scrapbook

Greet the patient.
Ask what brought her in today.
Be empathetic- ask What she thinks about it, what her husband feels about it.

-How many periods she has missed?
-What was her last LMP?
-Is this the first time she has missed any period?
-Is she having no vaginal bleeding or some spotting?
-Has she ever missed 3 periods in row before?
-Is there any chance you can be pregnant?

ASK ABOUT-
1. Pregnancy-LMP, fatigue, breast tenderness
2. Thyroid symptoms
3. Pituitary adenoma- galactoorohea, headache
4. Menopausal symptoms- vaginal atophy, hot flushes
5. PCOD- obesity, hirustism
6. Ask about diet, exercise, recent stress.

COMPLETE MENSTRUAL HISTORY-
-Age of menarche
-After how many days
-How long they last, volume, any cramps, mood/sleep problems
-Any bleeding in between periods.

Obstetrical history- GTPAL
-Have you ever been pregnant before.
-How many kids
-Any abortion- Spontaneous or therupatic
-Any excessive blood loss during last delivery- Shehan's syndrome

Gynaecological History-
-Contraception- OCPs, IUDs
-STDs, PID- no of seual partners, prefrences(male/female), anal/vaginal
-Last pap smear

Allergy-

Meds-OCPs
Anti-psychotics, anti-epileptics, chemptherapy, radiations

Past Medical History-
-Pelvic instumentation- Asherman, D/C, Cauterization
-Pelvic Surgery
-Psychiatric history- anorexia
-PID
-PCOD

Family History-
-PCOD
-Menstrual irregularity

Social history-
-Alcohol, smoking, ivdu, occupation
-How she feels about it
-How she is coping with it
-What her husband thinks about it
-Any idea what it could be

Explain your assessment and findings

PLAN-It could be- D/D
Plan- Will do P/E
- Will do certain blood tests
- If she agrees can discuss with husband
- Arrange F/U visit in 2 weeks

Work up-
-Beta-hcg
-TSH
-LH/FSH
-DHEAS, Serum prolactin
-Progestrone challenge test
-Hysteroscopy
-usg

bush5 · Credits: 1122 My Scrapbook

gr8 dr. tahir

rida · Credits: 251 My Scrapbook

excellent work ...thank u for ur effort
We can also add
if she is still lactating ( breast feeding)......its common cause of secondary amenorrhea ....
thanks again .......and GL

Kai1111 · Credits: 2036 My Scrapbook

Reallly appreciate the wonderfulwork,....but....if the history was entirely negative.....what investigations and ddx would we pursue?

If there is no galactorrhea/HAs/hirsutism/acne....would you bother with a Prolactin/DHEA/test levels?
If there was no instrumentation....doubtful Ashermanns.
Assume not pregnant, but,....you'd have to check this anyway.
If there was no wt loss, intense exercise, stress...doubtful low bmi amenorrhea.
If menstural hx normal...i.e. had normal menarche, periods, etc., till now...unlikely congental problem....etc....the question from the test bank said the "history was negative and the patient was not pregnant."

So, for investigations (can only choose 4):
1. hcg...if this wasn't necessary, glucose.
2. fsh/lh (may need to check only one in the test)
3. tsh
4. progesterone challenge

DDx
1. r/o diabetes
2. pco
3. hyperthyroid

This is a much appreciated review...my head is spinning....

Kai1111 · Credits: 2036 My Scrapbook

What is D/D? Its probably obvious, but, sadly, not to me... thanks.

bush5 · Credits: 1122 My Scrapbook

differential diagnosis

bush5 · Credits: 1122 My Scrapbook

D/D of secondary amenorrhoea

Pregnancy
excessive exercise, dieting
Anorexia nervosa
Lactation
Pituitary adenoma
Post Pill amenorrhoea
PCOS
Hypo/Hyper thyroidism
Sheehan syndrome
Asherman syndrome
premature ovarian failure
hypothalamic dysfunction

Kai1111 · Credits: 2036 My Scrapbook

in addition:

"Medications associated with amenorrhea include antipsychotics, tricyclic antidepressants, calcium channel blockers, methyldopa, reserpine, digitalis, and chemotherapeutic drugs."

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