2 - Gynae - Menstrual Cycle and its disorders - Amenorrhea + Oligomenorrhea

Question 1

what is primary amenorrhea? may be ? or ?
what is secondary amenorrhea?
what is oligomenorrhea?

Answer 1

• menstruation hasn’t started by 16 - could be delayed puberty (2’ sex char not present by 14), or menstrual outflow problem
• when prev normal menstruation ceases for more 6m or more
• menstruation occurs every 35d-6m

Question 2

Physiological causes???

Answer 2

preg
after menopause
usually during lactation
constitutional delay common and often familial

Question 3

pathological causes?

2’ amen/olig most commonly caused by:

Answer 3

drugs eg progestogens, GnRH analogues and antipsychotics
MAY LIE IN:
-hypothalamus, pituitary, thyroid, adrenals, ovary or uterus and outflow tract

PCOS, premature menopause, hyperprolactinaemia

Question 4

Hypothalamus

• what is common? due to 3 things?
• what is uncommon? how to r/o?
• what happens if hypothalamus is cause?
• supportive trt - 3 things?

Answer 4

hypothalamic hypogonadism - physiology, low weight/anorexia or XS exercise

• tumours - w MRI
• GnRH, LH, FSH, and oestradiol reduced
• monitor bone density, HRT/COCP, psych trt if needed

Question 5

Pituitary

• what happens? due to ? or ?
• what are rare?
• trt? 3 things

Answer 5

rare - pituitary tumours, sheehan’s necrosis

• hyperprolactinaemia from pit hyperplasia or benign adenomas
• trt - bromcriptine, cabergoline or sugery

Question 6

adrenal or thyroid

• what causes amenorrhea here? 2 things
• 2 rare things

Answer 6

rare things - CAH, virilising tumours

hyperthyroid > amenorrhea
hypothyroid > high prolactin and amenorrhea

Question 7

Ovary - acquired

- what condition? causes what? ass w what? premature menopause in?/100?

Answer 7

PCOS - common - ass w subfertility and long term complx
1’ or 2’ amenorrhea but olig more common
prem men in 1/100

Question 8

Ovary - congenital

• most commonly? gives normal ?, poor ?, short ?
• effect on ovary?

Answer 8

turners - one X Chr absent - short stature, poor 2’ sex characteristics, normal intelligence

gonadal dysgenesis - imperfect ovary formed

Question 9

Menstrual flow obstructed or absent

- acquired? causing? type of amenorrhea?

Answer 9

• usually 2’ amenorrhea, cervical stenosis -> haematometra

Question 10

Menstrual flow obstructed or absent

• congenital - type of amenorrhea? normal what? what obstructs flow?
• what happens to blood?
• trt?
• rare?

Answer 10

• 1’ amenorrhea, normal 2’ sex chars
• imperforate hymen and transverse vaginal septum
• rare - absent vagina
• blood pools in vagina (haematocolpos) or in uterus (haematometra)
• trt is surgical