Menstrual Irregularity: Hypothalamic, Pituitary & Ovarian Etiologies

This flashcard set covers the etiologies of menstrual irregularity across hypothalamic, pituitary, and ovarian categories including FHA, PCOS, and POI.

Functional Hypothalamic Anovulation/Amenorrhea (FHA)

A diagnosis of exclusion responsible for $30\%$ of secondary amenorrhea, seen in women with restricted food intake, excessive exercise, or significant chronic stress.

Hypogonadotropic Hypogonadism

A term describing the suppression of the H-P-O axis due to GnRH suppression, resulting in suppressed pituitary release of $FSH$ and $LH$ and suppressed gonadal production of hormones.

Hypoleptinemia

A condition resulting from a drop in fat mass that decreased leptin levels, leading to reduced hypothalamic kisspeptin and GnRH secretion.

Relative Energy Deficiency in Sport (RED-S)

Previously called Female Athletic Triad, it covers a range of symptoms including low energy availability, menstrual abnormalities (oligo- or amenorrhea), and bone density below expected age.

Kallman Syndrome

A congenital GnRH deficiency accompanied by anosmia that often presents with delayed puberty when there is a complete deficiency.

Prolactinoma

The most common pituitary tumor ($50\%$), it causes excessive prolactin production which suppresses GnRH secretion and may cause galactorrhea.

Sheehan’s syndrome

Ischemia necrosis of the pituitary gland, often resulting from maternal hemorrhage during childbirth.

Polycystic Ovary Syndrome (PCOS)

Recently renamed Polyendocrine Metabolic Ovarian Syndrome (PMOS), it is a syndrome of excess androgen production leading to anovulation and is the most common female endocrinopathy in reproductive age women ($5-10\%$).

Rotterdam Criteria

A diagnostic guideline for PCOS requiring 2 of 3 findings: hyperandrogenism, ovulatory dysfunction, and polycystic ovary morphology on ultrasound.

Hirsutism

A condition affecting $5-10\%$ of women causing the growth of excessive amounts of dark, coarse terminal hairs in male-type patterns, such as the face, chest, and back.

Ferriman Galloway scoring system

A scoring system used to quantify the extent and distribution of terminal hair growth in women to evaluate hirsutism.

Acanthosis Nigricans

A velvety, verrucous, hyperpigmented skin condition located on the neck, axillae, or vulva that serves as a sign of insulin resistance.

Sex hormone-binding globulin (SHBG)

A protein whose levels are reduced by insulin; lower levels increase the bioavailability of androgens in the body.

Spironolactone

An androgen receptor antagonist and aldosterone antagonist used at dosages of $25-100\,mg$ BID to treat hirsutism by inhibiting $5\,\alpha$ reductase.

Primary Ovarian Insufficiency (POI)

A condition characterized by hypergonadotropic hypogonadism, elevated gonadotropins ($FSH$), and a hypoactive gonad, previously referred to as premature ovarian failure.

Fragile X premutation (FMR1)

A genetic cause of POI involving $55-200$ CGG repeats; $12-28\%$ of individuals with this premutation experience menopause before age $40$.

Turner Syndrome

A genetic condition appearing in $1$ in $2{,}500-5{,}000$ liveborn girls, characerized by chromosomal abnormalities (most commonly $45,X$), short stature, webbed neck, and streak gonads.