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LO1: Relate the developmental anomalies of the uterus to the clinical presentations

Gross anatomy of female repro system (uterus) & compare with mullerian agenesis

Describe Normal Menstruation

Primary & secondary amenorrhea (Characteristics + causes)

Mullerian Agenesis (start with embryological basis with age, cause & sign symptom)

Galactorrhea (Def, causes and relate menstrual cycle and hormonal regulation)

Pelvic and vaginal examination

LO2: Relate the radiological findings to the clinical presentations

Compare normal and mullerian agenesis radiological findings

LO3: Discuss the psychosocial implications of infertility

MERCI & Management

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- describe normal menstruation (ovulation etc.)
- primary & secondary amenorrhea
- normal anatomy of female genital tract
- embryological basis of patient
- how it develops until patient is presented

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- Anatomy of female genital tract
- Amenorrhea : 1* , 2* and causes
- Normal menstrual cycle
- Galactorrhea : causes, relation with menstrual cycle, hormonal regulation related to milk production
- Mullerian agenesis
: age for diagnosis, signs and symptoms, causes, embryological basis
: compare with normal in terms of characteristic, radiological findings, etc
: general physical examination
: Differential diagnosis
: Management

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IVF, Surrogate mother, uterus transplant
MERCI

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- Mayer - rokitansky - kuster - hauser syndrome
- what age
- signs symptoms
- causes
- embryological basis

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- uncertain
- not enough information to conclude

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- vagina is short and blind end
- congenital anomalies
- Compare normal with Mullerian agenesis : characteristic, radiological findings such as MRI

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- not included in secondary sexual development
- present since child

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- PCOS
- tumours
- imperforated hymen (filled with fluid) (?)

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a milky nipple discharge unrelated to the normal milk production of breast-feeding
- causes ?
- relation with menstrual cycle ? Hormone regulation problem ?
- Regulation of prolactin ?

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1. Anatomical defect
2. Hormonal defect
3. Nutritional defect

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Characteristic between 1* and 2* amenorrhea

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Characteristic between 1* and 2* amenorrhea

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relate with normal processes of menstrual cycle

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Miss Cindy
20 years old = young, reproductive age, unmarried
no menses (menarche) since childhood = menstrual cycle haven't happen / obstruction

1* amenorrhea = absence of first period by age 14 with no pubertal change / age 16 with pubertal changes
2* amenorrhea = absence of period 6 months or more in woman who has previously menstruated

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On general examination, she looked well. Her height was 156 cm and weight was 52 kg. She had well-developed secondary sexual characteristics. Palpation of the abdomen did not reveal
any masses. Pelvic examination revealed a normal vulva. Her vagina was short with a blind end. Ultrasound showed inconclusive findings. Magnetic resonance imaging showed absence of uterus but both ovaries were seen. A diagnosis of Mullerian agenesis was made.
Miss Cindy was told that she is infertile

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Miss Cindy, a 20-year-old female college student presented to the gynaecology clinic with the complaint of still not having menses since childhood. On further history, she denied having
galactorrhoea.