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