Understanding Amenorrhea
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- čas přidán 4. 08. 2012
- In this video I discuss the basic physiology of the menstrual cycle and the mechanism behind the most common causes of amenorrhea like pregnancy, PCOS, premature ovarian failure, Asherman syndrome, stress, prolactinoma, hypothyroidism, Turner syndrome, Kallmann syndrome and others. I targeted this presentation toward fellow medical students, nursing students, health care professionals, and curious laymen. In part 2, I discuss the diagnostic approach to patients with amenorrhea. I hope you find this helpful.
Thank you sooooo much! I have primary amenorrhea. This video made me cry because, for years if research, no one has given informative facts like you. I'm going to wipe my tears and make my necessary appointments. God bless you sir. I'm happy doctors are speaking on this now :)
I have always respected the teachers like you, who don't hesitate taking the time to help others understand such difficult things like these. Even foreign layman with a different mother language and basic biology and biochemistry knowledge can easily understand your useful explanations. I was diagnosed with PCOS 3 years ago (after 1 year secondary amenorrhea), and now I am treated with metformin. My BMI normalized, but withdrawal of metformin ends up in amenorrhea again, and my androgens are high.I am trying to understand the causes of this, and your video I found very helpful, thank you!
Omg. I have an exam tomorrow, and in the past 3 days , I have never sat through someone explaining gynecology to me for more than 5 Mims. I got through this whole video sooo
smooth. You're awesome, thank you !!! Keep making em!!!!
Please keep doing these- Im in NP school and your amenorrhea video finally let the female hormones make sense! Im sure you have an amazing bedside manner! Thank you!!!
Thank you so much! this helps me a lot for my state exam in obstetrics gynecology next 2 weeks.. God bless u :) u r great in explaining and lecturing
thanks bill,
i'm an fnp student and your video was really helpful... i've shared it with my class. pretty amazing job!!
This was fantastic. Thank you!
This is great - incredibly comprehensive, well structured and felt interactive and personal - excellent teaching skills. Can you spare time to do more?!?
this is totally awesome. thanks so much for the video
thank you sir..... brilliant presentation
Thank YOU! The best explanation ever! 🙌
Amazing way!Never going to forget ever!👍👌
You make learning fun. Great video
Thanks for your efforts, you made amenorrhea very simple.
perfect!
tks better than anything i have read!
perfect explanation!
Thhhaaank u sooo much.. I was trying to understant it .. And u made it diagestable . god bless u
and so good u explained too detailed
Great !!! very informative ....thanks a lot doctor
Great man ,, love it
thankyou so much! very useful!
thank u for simplifying your lecture. i would love listening to this video than reading my book :)
Great video Doctor!
Thank you so much! It was really helpful. Kind regards from Perú!
This was excellent
This is absolutely wonderful. Thank you so much!
Amazing!!
Thank you.
thanx man, it really helps
why he is not making more videos & describing different topics!! he is perfecttt :(
im in Unibe, in DR.. not too far from each oter... i just checked out Saba... looks like a great med school
OMG- THANK YOU!!!
great vid...thanx
Thank u ver much
couldnt stop laughing!! Such a nice video!!
Thank you sir:)
Please sir, what books did you read? Never seen Kallman's explained with such clarity and simplicity before
Doesn't dopamine inhibit prolactin?
loved it... 3rd yeard med student here... what med school are u attending william?
Thank you very much.....:-):-)
Thanks! I'm from Saba. Where do you go?
Excellent detailed explanations
I have a question. You said that prolactin causes an increase in dopamine, which is antagonist to GnRH. But I found in the net that there is an inverse relationship between dopamine and prolactin. So, the more prolactin the less dopamin.
For many hormones controlled by the hypothalamic-pituitary axis, the hypothalamic hormone stimulates release of second hormone from the pituitary, and the second hormone exerts negative feedback on the hypothalamus, thereby maintaining homeostasis.
For example, thyroid hormone releasing hormone (TRH) stimulates the pituitary to release thyroid stimulating hormone (TSH). TSH levels increase, and TSH (and incidentally thyroxine and triiodothyronine, the hormones released from the thyroid gland in response to TSH) exert negative feedback on the hypothalamus, resulting in less TRH secretion.
The relationship between dopamine and prolactin is a little different, as you mentioned. Dopamine exerts what is known as tonic inhibition on the anterior pituitary lactotrophs to release dopamine. In other words, at baseline without dopamine influence, the anterior pituitary will automatically release prolactin. When the hypothalamic neurons release dopamine onto the anterior pituitary lactotrophs, prolactin secretion is inhibited.
However, just like the other hormones in the hypothalamic-pituitary axis, prolactin is capable of exerting negative feedback on its own secretion. However, given the unique relationship between dopamine and prolactin (that is to say, given the fact that dopamine normally inhibits prolactin secretion), the way that prolactin regulates its own secretion by negative feedback is by STIMULATING increased secretion of dopamine.
This should make sense. The concept is the same as it is with the relationship between TRH and TSH. For TRH and TSH, TSH inhibits the secretion of TRH which inhibits its own secretion because TRH stimulates TSH secretion. For prolactin, prolactin stimulates the secretion of dopamine which inhibits its own secretion because dopamine inhibits prolactin secretion.
In the case of a prolactinoma, there is an autonomous prolactin secreting tumor within the anterior pituitary that is no longer under tonic inhibition by dopamine. However, the prolactin released by the prolactinoma is still capable of exerting "negative feedback" onto the hypothalamus. How does it do this? It does this by stimulating the release of more dopamine in the hope that increased dopamine levels will further tonically inhibit the release of prolactin from anterior pituitary lactotrophs. This is why for purposes of negative feedback, the more prolactin secreted by an autonomous prolactinoma, the more dopamine you will get. The relationship is still an inverse one as you mentioned, but there is an added subtlety to the situation. Now there are two sources of prolactin: (1) The anterior pituitary lactotrophs (physiological) and (2) the prolactin-secreting prolactinoma (pathological). The relationship between dopamine and prolactin secretion from the anterior pituiatry lactotrophs is STILL an inverse one. The increased dopamine will inhibit secretion of prolactin from the anterior pituitary lactotrophs. However, the autonomous prolactin-secreting prolactinoma continues to secret prolactin in an unregulated fashion because it is not under control of dopamine.
i had to make a uterine curettage.after 2 months of amenorrhea my doctor told me it is a psychogenic problem but i think he badly made the curettage..thanks for explaining
Interesting
Great lecture!! Thanks for helping me to comprehend~~~
*perfect lucture doc*
Great video - will be useful for my endocrine exam. I upload educational videos too!
Stopped birth control (I had been taking it for 10 years) I haven’t had my period yet. It’s been 4 months. I’m definitely not pregnant
Sry but granulosa cells have both LH and FSH receptors I think.
👍👍
I have secondary anmanherha
He is still a 4th year Medical student..... Surprise,,Anyways Good Job
doc you so funny lol
thanx man, it really helps