AMENORRHEA

Question 1

2 TYPES

Answer 1

1. PRIMARY
2. SECONDARY

Question 2

WHAT IS PRIMARY AMENORRHEA?

Answer 2

defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development),

or

by 13 years of age in girls with no secondary sexual characteristics

Question 3

WHAT IS SECONDARY AMMENORHEA?

Answer 3

cessation of menstruation for 3-6 months in women with previously normal and regular menses,

or

6-12 months in women with previous oligomenorrhoea

Question 4

CAUSES PRIMARY AMENORRHOEA

Answer 4

gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes

testicular feminisation

congenital malformations of the genital tract

functional hypothalamic amenorrhoea (e.g. secondary to anorexia)

congenital adrenal hyperplasia

imperforate hymen

Question 5

CAUSES SECONDARY AMENORRHOEA (AFTER EXCLUDING PREGNANCY)

Answer 5

hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)

polycystic ovarian syndrome (PCOS)

hyperprolactinaemia

premature ovarian failure

thyrotoxicosis* - HYPOTHYROIDISM

Sheehan’s syndrome

Asherman’s syndrome (intrauterine adhesions)

Question 6

INITIAL INVESTIGATIONS

Answer 6

exclude pregnancy with urinary or serum bHCG

full blood count, urea & electrolytes, coeliac screen, thyroid function tests
gonadotrophin - RAISED GONADAL DYSGENESIS E.G. TURNERS AND LOW = PREMATURE OVARIAN FAILURE

prolactin

androgen levels - RAISED PCOS

oestradiol

Question 7

MANAGEMENT OF PRIMARY AMMENORRHOEA

Answer 7

investigate and treat any underlying cause
with primary ovarian insufficiency due to gonadal dysgenesis (e.g. Turner’s syndrome)

are likely to benefit from hormone replacement therapy (e.g. to prevent osteoporosis etC)

Question 8

MANAGEMENT OF SECONDARY AMENHORRHEA

Answer 8

exclude pregnancy, lactation, and menopause (in women 40 years of age or older)

treat the underlying cause