Amenhorrhoea

Question 1

What are the differences between primary and secondary amenorrhoea?

Answer 1

Primary - failure to start menses by the age of 16 years.

Secondary - cessation of established regular menstruation for 6 months or longer.

Question 2

What are some causes of primary amenorrhoea?

Answer 2

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

Question 3

What are causes of secondary amenorrhoea?

Answer 3

• Exclude pregnancy :-)
• Systemic
  
  • Thyrotoxicosis*/ Hypothyroidism
  • Hypothalamic amenorrhoea (e.g. Stress, excessive exercise)
  • Hyperprolactinaemia
  • Sheehan’s syndrome (Postpartum hypopituitarism)
• Structural
  
  • Asherman’s syndrome (intrauterine adhesions)
  • Polycystic ovarian syndrome (PCOS)
  • Premature ovarian failure

Question 4

What is the investigation pathway for amenorrhoea?

Answer 4

• Pregnancy test
• Female hormones: FSH, LH, Oestradiol - low levels in hypothalamic causes or raised in premature ovarian failure.
• Male hormones: Testosterone, DHEA: raised in PCOS or Adrenal tumours.
• Others: Prolactin, Thyroid function tests

Question 5

What is the most likely cause of her symptoms?

Premature ovarian failure, Prolactinoma, PCOS, Addison’s disease or Excessive exercise?

Answer 5

Excessive exercise. Bloods show a hypothalamic amenorrhoea which is caused by stress or excessive exercise.

FSH would be raised if it was ovarian failure.