Amenorrhea

Question 1

What is Menarche?

Answer 1

Onset of menstruation

Question 2

When should menarche occur?

Answer 2

Before the age of 16 (or 14 if no 2o sexual characteristics)

Question 3

Potential causes of delayed menarche?

Answer 3

• always exclude pregnancy
• constitutional delay is v common
• imperforate hymen
• low gonadotrophin secretion (tumour, stresses, panhypopit)
• High gonadotrophin secretion (gonadal damage, turners, steroid hormone enzyme deficiencies)
• testicular feminisation from DSD (rare)

Question 4

When would you suspect hormonal/anatomical causes of primary amenorrhea?

Answer 4

• anatomical if isolated delayed menarche

- hormonal if other features of puberty are affected

Question 5

How would you deal with pt presenting with testicular feminisation

Answer 5

Gonadectomy followed by oestrogen replacement

Question 6

What is secondary amenorrhea?

Answer 6

Absence of menstruation for 6 months

Question 7

What are the possible causes of secondary amenorrhea?

Answer 7

pregnancy
lactation
menopause.
low gonadotrophin secretion (tumour, stresses, panhypopit)
High gonadotrophin secretion (gonadal damage,