Amenorrhea Flashcards
What counts as oligomenorrhea?
Less than 9 periods a year
What 5 tests should all patients presenting with ameonorrhea have?
LH FSH Oestradiol Thyroid function Prolactin
What blood test should you perform if a patient has hirsutism?
Androgen levels
What test should you perform if a patient has a low oestrogen a low serum FSH and is having problems with vision.
Pituitary MRI
What hormone is low in female hypogonadism?
Oestrogen
High LH/FSH and low oestrogen.
Primary hypogonadism (hypergonadotrophic hypogonadism)
Low LH/FSH and low oestrogen
Secondary hypogonadism (hypogonadotrophic hypogonadism)
What genetic syndrome is associated with premature ovarian failure?
Turners
A female patient presents with ameonorrhea. What should her FSH measurements be to confirm a diagnosis of premature ovarian failure?
FSH of above 430 on 2 separate occasions 1 month apart
What genetic conditions causes a hypothalamic secondary hypogonadism?
Kallmans
No GnRH secretion + anosmia
Kallmans syndrome
What is the rotterdam criteria for PCOS?
2 out of:
- Menstrual irregularity
- Hyperandrogenism
- Polycystic ovaries
Give two reasons why you get androgen excess at the hair follicle in PCOS?
Excess circulating androgen
Increased peripheral conversion at the hair follicle
What is the most likely enzyme that is deficient in CAH?
21α-hydroxylase
Is CAH dominant or recessive?
Revessive
A lady presents with amenorrhea for the last 3 months. She has signs of virilisation and a serum testosterone level of 7nmol.
Androgen secreting tumour
What is the treatment for PCOS?
OCP Cyproterone acetate (often combined with OCP as dianette)
Name a local anti androgen cream
Efflornithine
What is the karotype in turners?
XO
What is testicular feminisation?
Androgen insensitivity syndrome. Genetically XY but phenotypically female.
A surge in what hormone causes ovulation?
LH
At which point in the menstrual cycle are oestrodial levels highest?
Before ovulation
At which point in the menstrual cycle are progesterone levels highest?
After ovulation
When should you measure progesterone levels?
Day 21 (Mid luteal)
When should you check levels of FSH, LH, estradiol, Prolactin, TSH and free androgens.
Day 2 - 5 (Early follicular phase)
Explain the progesterone challenge test.
5 - 7 days of progesterone given. When this is stopped there should be a bleed.
If there is a bleed: Oestrogen levels fine but no ovulation occurring.
If no bleed: Problem with the uterus itself or oestrogen levels are very low.
What is the free androgen index?
Serum testosterone/SHBG
Explain the WHO classification of amenorrhea?
Group 1: Hypothalamic pituitary failure
Group 2: Hypothhalamic pituitary dysfunction
Group 3: Ovarian problems
What are the management options for hypothalamic anovulation?
Pulsatile GnRH (SC or OV)
FSH and LH daily injections
Both need ultrasound tracking and monitoring of response
What are the biochemical test results in hypothalamic pituitary dysfunction?
Normal gonadotrophins
Normal oestrogen
Anovulation
How does insulin resistance lead to hyperandrogenism?
Insulin lowers SHBG levels and so increases free testosterone.
Name three theraputic options for the induction of ovulation in PCOS
- Clomifene citrate
- Daily FSH and LH injections
- Laproscopic ovarian dithermy
What is the first line treatment for induction of ovulation in PCOS?
Clomifene citrate
Name two dopamine agonists
Cabergoline
Bromocriptine
A patient who was being treated with dopamine agonists for a prolactinoma falls pregnant. What do you do?
Stop dopamine agonist.
