Amenorrhea Flashcards
Menstrual/ proliferative phase of the menstrual cycle
- Length
- Uterus
- Hormones
- Cervix
Length: 7-21 days
- Menstruation
- Fall of oestrogen and progesterone triggers shedding of the functionalis layer.
- Cervix dilates - Proliferation
- GnRH = rise in FSH= rise in oestrogen
- Follicular development, endometrial proliferation
- Peak in LH= ovulation
- Cervical mucus is watery and profuse during ovulation
Secretory and pre-menstrual phase
- Length
- Uterus
- Hormones
- Cervix
Length: always 14 days
- Menstruation will always happen 14 days after ovulation
Release of ovum from follicle leaves corpus luteum= secretion of progesterone
Endometrial glands proliferate under progesterone
- Becomes more tortuous with prominent spiral vessels
Physiological causes of amenorrhoea
Pregnancy
Menopause
Functional causes of amenorrhoea
Describes “non-organic” causes:
- Rapid weight loss/ anorexia nervosa/ low body far percentage
- Excessive exercise
- Prolonged psychological stress
Hypothalamic/pituitary causes of amenorrhoea
Functional: stress, low body fat percentage, excessive exercise
Tumours: pituitary macro adenoma, prolactinoma
Other intracranial lesions: pituitary haemorrhage, midline tumours (craniopharyngioma)
Endocrinological causes of amenorrhoea
Prolactinoma
Ovarian
- PCOS
- POI
- Menopause
- Genetic: Turner’s syndrome, Klinefelter’s
Thyroid disease
Anatomical causes of amenorrhea
Müllerian agenesis
Ashermann’ sydnrome
Outflow obstruction
- Cervical stenosis
- Imperforate hymen
- Transverse vaginal septum
Ashermann syndrome
- definition
- presentation
- causes
Acquired intrauterine adhesions
Presentation
- Amenorrhoea
- Abdominal distension
- Pelvic pain
- Recurrent miscarriage/ inferitility
Causes:
- Dilatation and curettage (following ectopic/ miscarriage)
- Previous myomectomy
Cervical stenosis
- Description
- Causes
- Presentation
- management
Narrowing of the cervix due to fibrosis/ mass.
Causes
- Previous cervical surgery: Cone biopsy, LLETZ procedure
- Endometrial/ cervical cancer
- Radiation
- Menopause (atrophy)
Presentation
- Asymptomatic
- Amenorrhoea
- Haematometra (uterus filled with blood)
Management
- Cervical dilation
Imperforate hymen
- Description
- Presentation
- Management
Hymen that covers the vaginal opening
Presentation
- Amenorrhoea
- Cyclic pelvic pain (around menstruation)
- Dyspareunia
- Difficulty inserting penis/ tampon
Management
- Incision
Primary ovarian insufficiency
- Definition
Cessation in menses >1 year before age 40.
Causes of primary ovarian insufficiency
Most common= Idiopathic
Autoimmune conditions
Toxins: chemotherapy, radiation
Risk factors for POI
- Family history
- Chemo/ radiation
- Fragile X syndrome FHx
- Galactoseamia
Complications of POI
Bones
- Osteoporosis/ Osteopenia= increased fracture risk
Skin and mucous membranes
- Dry skin
- Atrophic vaginitis, painful sex
Subfertility
Increased CVD morbidity and mortality
Presentation of POI
Amenorrhoea/ Oligmenorrhea
Menopausal symptoms
- Hot flushes
- Cognitive difficulties
- Insomnia
- Dry skin/ brittle hair
- Irritability
Vaginal dryness
