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4: Y4 - Gynaecology [8] > [43] Amenorrhoea > Flashcards

[43] Amenorrhoea Flashcards

1
Q

What is amenorrhoea?

A

The absence of menstrual periods

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2
Q

How can amenorrhoea be classified?

A
  • Primary

- Secondary

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3
Q

What is oligomenorrhoea?

A

Irregular periods with intervals between menstrual cycles of more than 35 days and/or less than 9 periods per year

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4
Q

What is primary amenorrhoea?

A

Failure to commence menses

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5
Q

When can primary amenorrhoea be diagnosed in the absence of secondary sexual characteristics?

A

In girls 14+

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6
Q

When can primary amenorrhoea be diagnosed in the presence of secondary sexual characteristics?

A

In girls 16+

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7
Q

What are some examples of secondary sexual characteristics?

A
  • Pubic hair

- Breast development

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8
Q

What is secondary amenorrhoea?

A

When there is cessation of periods for > 6 months after menarche

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9
Q

Can causes of secondary amenorrhoea cause primary amenorrhoea?

A

Almost always, if they are established before menarche

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10
Q

What are some specific causes of primary amenorrhoea in the presence of secondary sexual characteristics?

A
  • Constitutional delay
  • Genitourinary malformations
  • Testicular feminisation (androgen resistance syndrome)
  • Hyperprolactinaemia
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11
Q

What is constitutional delay of menarche?

A

Where there is no abnormality but the girl is a little later than her peers in reaching menarche

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12
Q

What is a useful part of the history in identifying constitutional delay of menarche?

A

History of menarche in mother and sisters

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13
Q

What genitourinary malformations can lead to primary amenorrhoea in presence of secondary sexual characteristics?

A
  • Imperforate hymen
  • Transverse vaginal septum
  • Absence of uterus or vagina
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14
Q

What karyotype does androgen resistance syndrome occur in?

A

XY

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15
Q

What is the external appearance in androgen resistance syndrome?

A

Normal adolescent girl

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16
Q

What is the internal appearance in androgen resistance syndrome?

A

No female internal organs and gonads are testosterone producing testes

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17
Q

How can the presentation of androgen resistance syndrome vary?

A

On the degree of androgen sensitivity

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18
Q

What can cause hyperprolactinaemia leading to primary amenorrhoea?

A
  • Hypothyroidism
  • Medication
  • Pituitary tumours
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19
Q

What medications can lead to hyperprolactinaemia leading to primary amenorrhoea?

A

Phenothiazines

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20
Q

What can cause primary amenorrhoea in the absence of secondary sexual characteristics?

A
  • Ovarian failure
  • Other causes of failure of the HPA
  • Causes of ambiguous genitalia
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21
Q

What can cause ovarian failure leading to primary amenorrhoea?

A
  • Chemotherapy
  • Irradiation
  • Chromosomal gonadal abnormality
  • Developmental abnormality
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22
Q

What chromosomal abnormality can lead to primary amenorrhoea?

A

Turner’s syndrome

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23
Q

What developmental abnormality can lead to primary amenorrhoea?

A

Mullerian agenesis

24
Q

What can cause failure of the HPA leading to primary amenorrhoea?

A
  • Tumours
  • Irradiation
  • Infection
  • Head injury
25
Q

What can cause ambiguous genitalia leading to primary amenorrhoea?

A
  • Androgen secreting tumours

- Congenital adrenal hyperplasia

26
Q

What is the most common cause of secondary amenorrhoea in women of childbearing age?

A

Pregnancy

27
Q

What are the causes of secondary amenorrhoea with no signs of androgen excess?

A
  • Physiological causes
  • Premature ovarian failure
  • Depot and implant contraception
  • Cervical stenosis and intrauterine adhesions (Asherman’s syndrome)
  • Hypothalamic dysfunction
  • Loss of weight
  • Pituitary disease and hyperprolactinaemia
  • Thyroid disease
  • Iatrogenic
28
Q

What are the physiological causes of secondary amenorrhoea?

A
  • Pregnancy
  • Lactation
  • Menopause
29
Q

What can be the causes of premature ovarian failure leading to secondary amenorrhoea?

A
  • Autoimmune
  • Radiotherapy
  • Chemotherapy
30
Q

What can cause hypothalamic dysfunction leading to secondary amenorrhoea?

A
  • Stress
  • Excessive exercise
  • Eating disorders
  • Depression
  • Chronic systemic illness
  • Tumours
31
Q

What can cause pituitary disease and hyperprolactinaemia leading to secondary amenorrhoea?

A
  • Medication

- Recreational drugs

32
Q

What are the iatrogenic causes of secondary amenorrhoea?

A
  • Medication
  • Surgery
  • Irradiation
  • Chemotherapy
33
Q

What surgeries can lead to secondary amenorrhoea?

A
  • Hysterectomy
  • Endometrial ablation
  • Ovarian surgery
34
Q

What are some signs of androgen excess in women?

A
  • Hirsutism
  • Acne
  • Virilisation
35
Q

What are some causes of secondary amenorrhoea in the presence of signs of androgen excess?

A
  • PCOS
  • Cushing’s syndrome
  • Late-onset congenital adrenal hyperplasia
  • Adrenal or ovarian carcinoma
36
Q

What % of amenorrhoea cases can be caused by PCOS?

A

30%

37
Q

What should be asked about in the history when assessing amenorrhoea?

A
  • Duration
  • Contraception - recent and current
  • Vasomotor symptoms
  • Galactorrhoea
  • Exercise habits
  • Stresses
  • Medication history
  • PMH
38
Q

What features should be looked for on examination in amenorrhoea?

A
  • BMI
  • Signs of excessive androgens
  • Signs of thyroid disease or Cushing’s syndrome
39
Q

What investigations should be made into amenorrhoea?

A
  • Pregnancy test
  • FSH and LH
  • Prolactin
  • Total testosterone and sex hormone-binding globulin
  • TFTs
  • Pelvic USS
40
Q

What types of pregnancy test are available?

A

Urine or serum hCG

41
Q

When are FSH and LH raised in amenorrhoea?

A

Ovarian failure

42
Q

What can low FSH or LH suggest as the cause of amenorrhoea?

A

Constitutional delay or hypothalamic cause

43
Q

What might raised testosterone indicate as the cause of amenorrhoea?

A
  • Androgen secreting tumour

- Late-onset CAH

44
Q

When might slightly elevated testosterone levels be seen?

A

PCOS

45
Q

In what condition might pelvic ultrasound be helpful?

A

PCOS

46
Q

When should a pelvic ultrasound be performed to check for normal anatomy?

A

In young girls who are not sexually active

47
Q

What may be appropriate for some women in terms of investigation for amenorrhoea?

A

Referral and additional investigation

48
Q

What additional investigations may be appropriate for some women with amenorrhoea?

A
  • Karyotyping
  • MRI or CT
  • Hysteroscopy
49
Q

When might karyotyping be appropriate in amenorrhoea?

A

To exclude Turner’s syndrome, testicular feminisation, and rare conditions

50
Q

When might MRI or CT be appropriate in amenorrhoea?

A

Where pituitary tumour is suspected

51
Q

When might hysteroscopy be appropriate in amenorrhoea?

A

In suspected Asherman’s syndrome

52
Q

What does the management of amenorrhoea depend on?

A

Underlying cause and priorities of the woman

53
Q

What should be done in women with amenorrhoea and low oestrogen levels/

A

Assess for the risk of osteoporosis

54
Q

What conditions cause amenorrhoea and low oestrogen levels?

A
  • Premature ovarian failure
  • Hypothalamic causes
  • Hypopituitarism
  • Hyperprolactinaemia
55
Q

What should be done in women with amenorrhoea at risk of osteoporosis?

A

Ensure they have adequate calcium and vitamin D intake

4: Y4 - Gynaecology [8] (52 decks)

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