Amenorrhoea Flashcards
What is amenorrhoea?
Absence or missed menstruation
What is primary amenorrhoea?
The failure to establish menstruation by 15 in girls with normal secondary sexual characteristics
Or by 13 years of age in girls with no secondary sexual characteristics
What is secondary amenorrhoea?
Cessation of menstruation for 3-6 months in women with a previously normal and regular menses
Or by 6-12 months in women with previous oligomenorrhoea
What is the most common cause of primary amenorrhoea?
Gonadal dysgenesis (e.g. Turner’s syndrome)
What are other possible causes of primary amenorrhoea?
Testicular feminisation
Congenital malformations of the genital tract
Functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
Congenital adrenal hyperplasia
Imperforate hymen
What are the causes of secondary amenorrhoea?
Hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
Polycystic ovarian syndrome (PCOS)
Hyperprolactinaemia
Premature ovarian failure
What would you exclude first in someone presenting with amenorrhoea?
Pregnancy
How would you exclude pregnancy?
Urinary or serum bHCG
What other investigations should be carried out?
Full blood count, urea & electrolytes, coeliac screen, thyroid function tests
Oestradiol
Prolactin
What would a low level of gonadotrophins indicate?
Hypothalamic cause
What would a raised level of gonadotrophin cause?
Ovarian problem
What are 2 possible causes of raised gonadotrophins?
Premature ovarian failure
Gonadal dysgenesis- Turner’s syndrome
What is a possible cause of raised androgen levels?
Polycystic ovarian syndrome
What is the management of primary amenorrhoea?
Investigate and treat the underlying cause
What is the management of primary amenorrhoea due to gonadal dysgenesis?
Hormone replacement therapy
