February Dutch Webinar on Secondary Amenorrhea

Welcome and Introduction

• Presenter: Noah Reed, VP of Sales and Marketing for Precision Analytical (Creators of the Dutch Test)
• Guest Speaker: Dr. Tori Hudson, expert in women’s health
• Topic: Secondary Amenorrhea

Resources and Announcements

• Visit dutchtest.com for educational resources and hormone-related issue treatments.
• Coming soon: full online education course for registered Dutch providers.
• Special offer: 50% off first five test kits for new Dutch providers.
• Access to today’s slides via control panel; webinar recording available via email.
• Disclaimer: Webinar content is for educational purposes only, not clinical advice.

Speaker Introduction

• Dr. Tori Hudson
  • Naturopathic Physician, graduated from the National College of Naturopathic Medicine in 1984.
  • Multiple roles in academia including Professor, Medical Director, and Academic Dean.
  • Current roles: Adjunct Clinical Professor at Southwest College of Naturopathic Medicine and Bastyr University, Medical Director of her clinic “A Woman’s Time” in Portland, Oregon.
  • Director of Product Research and Education for Vitanica.
  • Founder & Co-director of Naturopathic Education and Research Consortium.
  • Recipient of the 2021 Freddy Kronenberg Excellence in Research and Education in Botanicals for Women’s Health Award.
  • Nationally recognized author, speaker, educator, researcher, and clinician.

Overview of Secondary Amenorrhea

• Definition: Absence of menstruation for 3 months in women with previous regular cycles, or 6 months in women with irregular cycles.
• Distinct from Primary Amenorrhea:
  • Primary Amenorrhea: no menstruation by age 14 without secondary sexual characteristics or by age 16 with secondary sexual characteristics.
• Importance: linked to 20% of infertility cases.

Evaluation and Diagnosis

• Compartmental Analysis:
  1. Outflow Tract Issues: e.g., cervical stenosis, damaged uterus.
  2. Ovarian Issues
  3. Anterior Pituitary Issues
  4. Central Nervous System Issues (Hypothalamic factors)
• History and Physical Exam:
  • Assess stress, nutritional status, eating disorder, excessive exercise.
  • Family history of genetic disorders.
  • Medication history (chemotherapy, radiation, etc.).
  • Menstrual history, presence of other chronic illnesses.
  • Signs of galactorrhea, hirsutism, acne, hair loss, body mass index (BMI).
• Initial Tests:
  • Baseline Testing: Pregnancy test, TSH, Serum prolactin.
  • Additional Testing: If initial tests are normal, proceed with Progesterone Challenge Test.

Progesterone Challenge Test

• Purpose: Assess endogenous estrogen level and outflow tract competence.
• Methods:
  1. Medroxyprogesterone acetate (MPA) 10mg/day for 5 days
  2. Oral micronized progesterone 300-400mg/day for 5-7 days
• Outcome:
  • Bleed: Diagnosis of anovulation.
  • No Bleed: Further evaluation needed to understand if the problem is uterine or HPO axis.

Further Evaluation (If no bleed)

• Estrogen and Progestogen Test: Evaluate uterine reactivity.
  • Oral estrogen (conjugated equine estrogen or estradiol) for 21 days followed by MPA.
  • Birth control pill with a 30-microgram dose.
  • Outcome: Determines if the issue is within compartment 1 (uterus/outflow tract).

Serum FSH and LH Test

• Evaluates if lack of estrogen is due to ovarian follicles (gonadotropins or follicular activity).
• Outcomes:
  • Elevated FSH/LH: Ovarian failure (possible premature ovarian failure/premature ovarian insufficiency).
  • Normal FSH/LH: Hypothalamic amenorrhea.
  • Low FSH/LH: Possible CNS or pituitary issue, evaluate with x-ray.

Treatment Approaches

• Importance of Accurate Diagnosis: Tailor treatments to the specific cause of secondary amenorrhea.
• Potential Treatments:
  • Premature Ovarian Insufficiency: Hormone therapy (estrogen and progestogens) until a standard menopausal age to prevent osteoporosis, heart disease, Alzheimer’s.
  • Lifestyle Modifications: Nutritional support, exercise, address stress factors.
  • Herbal Treatments: Vitex, Maca, black cohosh, flax seeds for certain conditions.
  • PCOS Specific: Addressing hyperandrogenism and insulin resistance with supplements such as N-acetylcysteine, myoinositol.
  • Hyperprolactinemia: Vitex, possibly B6 for prolactin modulation.
• Considerations for Long-Term Health: Bone density, cardiovascular health, cognitive function.

Additional Resources

• Upcoming Seminar: Menopause Hormone Boot Camp in April provided by the Institute of Women’s Health.
• Contact Information: For further questions, email [email protected].