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Gynaecology > 1: Menstruation: Amenorrhoea and Oligomenorrhoea > Flashcards

1: Menstruation: Amenorrhoea and Oligomenorrhoea Flashcards

1
Q

Define amenorrhoea

A

absence of menstruation

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2
Q

How is amenorrhoea classified

A

primary and secondary

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3
Q

Define primary amenorrhoea

A
  • Failure of periods to onset from 14-years if no secondary sexual characteristics
  • Or, 16-years if secondary sexual characteristics
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4
Q

Define secondary amenorrhoea

A

Absence of periods for 6-months after menstruation started

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5
Q

What are 4 causes of primary amenorrhoea

A

Turner’s
Congenital adrenal hyperplasia
Congenital malformations of genital tract
Testicular feminisation

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6
Q

What is the most common cause of secondary amenorrhoea

A

Pregnancy

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7
Q

What are the causes of secondary amenorrhoea

A
  • Functional disorders
  • Kallman’s
  • Hyperprolactinaemia
  • Thyrotoxicosis
  • PCOS
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8
Q

What is the role of the hypothalamus in menstruation

A

Release GnRH

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9
Q

What 3 disorders can cause amenorrhoea due to affecting hypothalamus

A

Kallman
Functional
Thyroid disease

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10
Q

What are 2 functional disorders that can reduce GnRH at the hypothalamus

A

Anorexia

Excessive exercise

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11
Q

What is kallmann syndrome

A

X-linked recessive condition that causes failure of GnRH neurons to migrate to the hypothalamus

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12
Q

How does kallmann syndrome present

A

Anosmia

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13
Q

Why is kallmann syndrome rare cause of amenorrhoea

A

As it is x-linked recessive and females have two x-linkec chromosomes

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14
Q

What are the 3 hypothalamic causes of amenorrhoea

A

Functional
Kallman
Thyrotoxicosis

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15
Q

What are 4 pituitary causes of amenorrhoea

A
  1. Sheeman’s
  2. Cranial Irradiation
  3. Post-contraception amenorrhoea
  4. Prolactinoma
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16
Q

Explain how prolactinomas result in amenorrhoea

A

Prolactinomas is a pituitary tumour that results in hyper-secretion of prolactin. Prolactin inhibits GnRH leading to secondary amenorrhoea.

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17
Q

What are the presenting features of prolactinoma

A

Amenorrhoea and galactorrhea

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18
Q

What other pituitary tumours can cause amenorrhoea

A

Pituitary adenoma - due to compression

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19
Q

What is Sheehan’s syndrome

A

Massive obstetric haemorrhage leads to ischaemic necrosis of the pituitary gland resulting in hormone deficiency

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20
Q

How does Sheehan’s syndrome present

A

Deficiency in several pituitary hormones

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21
Q

Explain post-contraception amenorrhoea

A

Prolonged used of contraceptives can cause long-term down regulation of the pituitary gland

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22
Q

What is the main contraceptive that causes post-contraception amenorrhoea

A

Depo provea

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23
Q

How long can it take periods to return in depo proved

A

18-months

24
Q

What are 3 ovarian causes of amenorrhoea

A
  1. PCOS
  2. Turner’s
  3. Pre-mature ovarian failure
25
Q

How does PCOS classically present

A

Oligomenorrhoea (Opposed to amenorrhoea)

26
Q

What is the genetics of turner’s syndrome

A

45XO

27
Q

What is turner’s syndrome

A

Genetic condition that causes:

  • Amenorrhoea
  • Absence secondary sexual characteristics
  • Infertility
28
Q

What are common phenotypic presentations of Tuner’s Syndrome

A
  • Short stature
  • Webbed neck
  • Aortic coarctation
  • Bicuspid aortic valve (lead to aortic stenosis)
29
Q

What is an ‘adrenal’ cause of amenorrhoea

A

Congenital adrenal hyperplasia

30
Q

What is congenital adrenal hyperplasia

A

Absence of 21-OH

31
Q

What are 4 anatomical causes of amenorrhoea

A

Imperforate hymen
Asherman syndrome
Transverse vaginal septum
Mayer-Rokitansky-Kuster-Hauser syndrome

32
Q

What is ashermanns syndrome

A

Instrumentation to the uterus causes damage to basal layer of the uterus, meaning it can no longer respond to oestrogen

33
Q

What procedure is the most common cause of ashermanns syndrome

A

Surgical management of miscarriage

34
Q

what is an imperforate hymen

A

No opening in the vagina

35
Q

how does imperforate hymen present clinically

A
  • Asymptomatic before puberty

- At puberty there is primary amenorrhoea and lower abdominal pain

36
Q

how does an imperforate hymen present on examination

A

Bulging, blue-is tinge to the hymen

37
Q

what is a transverse vaginal septum

A

Failure re-cannalisation of mullerian duct, cause cervical hypoplasia

38
Q

what is mayer-rokitansy-kust-hauser syndrome

A

Failure mullerian duct to develop

39
Q

what does agenesis of the mullein duct cause

A

Absence uterus and upper two-thirds of vagina

40
Q

what is first line secondary amenorrhoea

A

Pregnancy test

41
Q

what blood tests are ordered in amenorrhoea

A

TFT
FSH, LH
Prolactin
17-OH Progesterone

42
Q

why are TFTs ordered

A

Thyrotoxicosis - as hyperthyroidism can cause amenorrhoea at hypothalamus

43
Q

Why is prolactin ordered

A

Exclude prolactinoma

44
Q

Why is FSH and LH ordered

A

Exclude PCOS

45
Q

Why is 17-OH progesterone ordered

A

CAH

46
Q

When may karyotyping be ordered in amenorrhoea

A

Exclude Tuner’s syndrome as cause primary amenorrhoea

47
Q

Why may an US scan be ordered in amenorrhoea

A

Exclude anatomical obstructive causes

48
Q

Explain the progesterone challenge

A

Progesterone is given for 5-10d, or one-off dose.
Positive test is shown by bleeding in 2W.

Positive test indicates sufficient oestrogen, however individual is not ovulating (such as in PCOS).
Negative test indicates insufficient oestrogen to cause proliferation and hence ‘no secretion’

49
Q

Explain managing amenorrhoea

A

Treat underlying cause. Aims include:

  • Regulate periods
  • Regulate/Replace hormones
  • Fertility
  • Symptom control
  • Surgery if pituitary cause
50
Q

What may be given to regulate periods

A

COCP or POP

51
Q

What is the advantage of regulating periods in amenorrhoea

A

Stops hyper-proliferation of the endometrium which increases risk of endometrial cancer

52
Q

Define oligomenorrhoea

A
  • Less than 9 periods a year

- More than 35 days between periods

53
Q

What is the commonest cause of oligomenorrhoea

A

PCOS

54
Q

Give 5 causes of oligomenorrhoea

A
  1. PCOS
  2. Transient anvoulation (Stress-induced)
  3. COCP
  4. Perimenopause
  5. Hypothyroidism
  6. Medications
  7. Anorexia
55
Q

Explain management of oligomenorrhoea

A

Treat underlying cause. May aim to induce regular periods by using COCP

56
Q

What number of periods for PCOS is recommended per year and why

A

3 periods - to reduce risk of endometrial cancer

Gynaecology (22 decks)

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