Scribd
Upload
36 views56 pages

Amenore: Pembimbing: Dr. Putri Sekar W, Spog (K)

This document defines amenorrhea and discusses its causes and classifications. It defines primary and secondary amenorrhea and describes 4 categories of amenorrhea based on breast and uterus development. The categories include disorders of the ovaries, hypothalamus/pituitary, mullerian ducts, and eugonadotropic causes. Various inherited and acquired conditions are provided as examples for each category. Diagnostic tests and treatment approaches are also summarized.

Uploaded by

Mc Robert Jr
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
36 views56 pages

Amenore: Pembimbing: Dr. Putri Sekar W, Spog (K)

This document defines amenorrhea and discusses its causes and classifications. It defines primary and secondary amenorrhea and describes 4 categories of amenorrhea based on breast and uterus development. The categories include disorders of the ovaries, hypothalamus/pituitary, mullerian ducts, and eugonadotropic causes. Various inherited and acquired conditions are provided as examples for each category. Diagnostic tests and treatment approaches are also summarized.

Uploaded by

Mc Robert Jr
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 56

Amenore

Pembimbing : dr. Putri Sekar W, SpOG (K)


Definisi
Primer :
• Mens (-), ≥14 th, seks sekunder (-)
• Mens (-), ≥ 16 th, normal seks sekunder
Seknder
• Pada perempuan yg sudah mens sebelumnya, mens (-) ≈ 6 bulan 3 siklus berturut-turut

Speroff 2011
Breast staging
Pubic hair dev
Penyebab amenorhea
Kategori
Kategori 1 : payudara (-) uterus (+)
Sindrom Turner
Sindrom Turner
17-α hydroxylase def
Hypogonadotrophic hypogonadism
KATEGORI 2 : Payudara (+) uterus (-)
Dukts mulleri
Klasifikasi kelainan duktus mulleri
KATEGORI 3 : Payudara (-), uterus (-)
Kateori 4 : payudara (+), uters (+)
Causa amenore sekunder
Kompartemen I
Kompartemen II
• Ovarian failure ( hypergonadrotrophic hypogonadism )
POF  < 40 th, FSH > 40 mIUml
Kompartemen II
Kompartement II
Kompartement III
Kompartement III
Kompartemen IV
• Amenorhea hipotalamik
Hipotalamik
Functional hypothalamic amenorhea
Anatomik
Ovarium
• Inherited
Hypotamalamus
(Hypogonadotropic hypogadism)
Inherited • Stress
• Idiopathic hypogonadotropic • Destructive processes
hypogonadism (IHH)
• Tumor
• Kallmann syndrome • Radiation
Acquired
• Trauma
• Hypothalamic amenorrhea (“functional”) • Infection
• Eating disorders • Infiltrative disease
• Excessive exercise • Pseudocyesis
Hypophyse
(Hypogonadotropic hypogadism)
Inherited Chronic disease
• Pituitary hypoplasia • End-stage kidney disease
Acquired • Liver disease
• Adenoma • Malignancy
• Prolactinoma • Acquired immunodeficiency syndrome (AIDS)
• Destructive processes • Malabsorption syndromes
• Macroadenoma
• Metastases
• Radiation
• Trauma
• Infarction (Sheehan syndrome)
• Infiltrative disease
Eugonadotropic Amenorrhea
Inherited
• Polycystic ovarian syndrome
• Adult-onset congenital adrenal hyperplasia
• Ovarian tumors (steroid producing)
Acquired
• Hyperprolactinemia
• Thyroid disease
• Cushing syndrome
• Acromegaly
Laboratorium
Kadar estrogen serum
• Progesteron withdrawal test
Kadar FSH dan LH
Laboratorium
• Kadar free T4/ TSH , N: 0,4-4,5uIU/ml
• Kadar prolactin serum , N: 15-20 ng/ml
Uji P
Uji P
Uji E+P
Uji E+P
Uji E+P
Uji Clomifen
Uji GnRH
Progestin challenge / withdrawal
Tatalaksana
• Sesuai dengan etiologi
• Tidak ingin hamil  Estrogen + progesterone replacement untuk mencegah osteoporosis
• Ingin hamil
• PROGESTIN TEST (+)  induksi ovulasi dg clomifen sitrat 50 mg sehari selama 5 hari
• PROGESTIN TEST (-)
• Asherman  hysteroscopy
• Hypotalamic  GnRH pulsatil
• POF  IVF
Terima Kasih

You might also like