5.1 menstrual disorders Flashcards
what is primary amenorrhoea?
‘Primary’ amenorrhoea refers to when menstruation has not yet started by the age of
16 years in the presence of normal secondary sexual characteristics, or 14 years in the absence of other evidence of puberty.
Causes could be congenital, problems with the HPA axis or anatomical abnormalities
what is secondary amenorrhoea?
‘Secondary’ amenorrhoea refers to absent periods for at least 6 months in a woman who has previously had regular periods, or 12 months if she has had oligomenorrhoea (bleeds less frequently than 6 weekly).
Causes are usually due to a problem with the HPA axis
what are some physiological causes of amenorrhoea?
childhood
pregnancy
luring lactation
after the menopause
what is the overlap between primary and secondary amenorrhoea?
The overlap in presentation of primary and secondary is because “secondary” causes may present as primary if they happen early enough in life
what is the most common cause of primary amenorrhoea with normal secondary sexual characteristics?
gentiourinary malformations such as inperforate hymen, a vagnial septum, absent vagina or absent uterus
what is a imperforate hymen?
congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during fetal development. It is most often diagnosed in adolescent girls when menstrual blood accumulates in the vagina and sometimes also in the uterus.
if the mullerian duct and urogenital sinus do not join correctly in development, how will this affect menstration?
incomplete joining would leave a gap between the uterus and vagina, and the correct outflow tract would not be created. clood flow would accumulate in the peritoneal cavity.
what might cause primary amenorrhoea without second sexual characteristics developing?
constitutional delay of puberty idiopathic hypogonadotrophic hypogonadism Kallmann syndrome complete androgen insensitivity syndrome Turners syndrome
what is turners syndrome?
A genetic disorder where there is loss of one of the sex chromosomes of the 23rd pair. the karyotype is therefore 45XO. Ovary does not complete its normal development and instead under goes dysgenesis.
what hormonal abnormalities are present in a person with turners syndrome?
low oestrogen
high FSH and LH due to no negative feedback from oestrogen
what is complete androgen insensitivity syndrome?
X-linked recessive disorder
Resistant to testosterone due to a defect in the androgen receptor. excess testosterone then converted to oestrogen. 46XY but normal female phenotype (external). Testes may be palpable in the labia or inguinal area. Absence of the upper vagina, uterus, and fallopian tubes. The testes should be surgically excised after puberty
what is isolated GnRH deficiency?
A disease of the hypothalamus which is characterized by absent or incomplete sexual maturation by the age of 18, in conjunction with low levels of circulating gonadotropins and testosterone and no other abnormalities of the hypothalamo–pituitary axis.
what is Kallman syndrome?
condition characterized by delayed or absent puberty and an impaired sense of smell.
what are anatomical causes for secondary amenorrhoea?
Scarring
• Cervical stenosis
• Asherman syndrome (intrauterine adhesions)
Ovarian disorders
• Primary ovarian insufficiency (POI) – “Premature menopause”
what is Asherman syndrome?
absence of menses because of endometrial scarring or cervical stenosis resulting from injury or disease.
what is primary ovarian insufficiency?
premature menopause - depletion of oocytes before age of 40. No oestrogen, no inhibin and high FSH due to loss of feedback.
