Amennorhea

Question 1

Define amenorrhea

Answer 1

Absence in menses

Question 2

Primary amenorrhea

Answer 2

No menses by age 14 if no secondary sexual features present

No menses by age 16 but secondary features present

Question 3

Secondary amenorrhea

Answer 3

six months in women with previously normal menstruation

12 months in women with previous oligomenorrhea

Question 4

Causes of primary amennorhea

Answer 4

Mullerian agenesis
Vaginal atresia
Turner syndrome
Androgeen insensitivity syndrome
Kallman syndrome

Question 5

Causes of secondary amennorhea

Answer 5

Asherman's syndrome
Pregnancy
Anovulation
Menopause
PCOS
Breastfeeding 
Sheehan syndrome

Question 6

Polycystic ovarian syndrome

Found in 20% of all women

Answer 6

A complex endocrine disorder with clinical features that include hirsutism and acne (due to excess androgens), oligomenorrhoea or amenorrhoea, and multiple cysts in the ovary

Question 7

Signs and symptoms (clinical features)

Answer 7

Oligomennorhea (75%)
Infertility 
Hirsutism (60%)
Acne (15-25%) look for acne persisting beyond adolescence 
Obesity 
HTN

Question 8

Diagnosing PCOS

Answer 8

Polycystic ovary syndrome (PCOS) should be diagnosed if two of three of the following criteria are present, as long as other causes of menstrual disturbance and hyperandrogenism are excluded:

1. Infrequent or no ovulation (usually manifested as infrequent or no menstruation).
2. Clinical or biochemical signs of hyperandrogenism (such as hirsutism, acne, or male pattern alopecia), or elevated levels of total or free testosterone.
3. Polycystic ovaries on ultrasonography, defined as the presence of 12 or more follicles in at least one ovary, measuring 2–9 mm diameter, or increased ovarian volume (greater than 10 mL).

Question 9

PCOS treatment general

Answer 9

Screening for impaired glucose tolerance and T2DM
Lifestyle changes (weight loss)
Metformin

Question 10

PCOS treatment wants fertility

Answer 10

Clomifene: selective oestrogen receptor modulator, causes release of GnRH.
Gonadotrophins: follitropin alpha/beta

Question 11

PCOS treatment hirsutism only

Answer 11

Oral contraceptive

Anti-Androgen: Spiranolactone or Flutamide

Question 12

PCOS oligo-amenorrhea only

Answer 12

weight loss

Oral contraceptive

Question 13

Premature ovarian failure

Answer 13

Cessation of menses for at least 1 year before 45 secondary to loss of ovarian function

Question 14

Causes of premature ovarian failure

Answer 14

Genetic disorders
autoimmune disorders
infections
toxic causes (including chemotherapy or radiation)
galactosaemia
idiopathic.

Question 15

Tests to order

Answer 15

Pregnancy test
Serum FSH and LH (hypergonadotropism)
Estradiol (low)
serum antimullerian hormone (AMH) level (drops during menopause)
TFTs: exclude endocrinological problems

Question 16

Clinical features of POF

Answer 16

Same as menopause

Question 17

Treatment

Answer 17

HRT