Amenorrhoea Flashcards
What is primary amenorrhoea?
It is defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development)
OR
It is defined as the failure to establish menstruation by 13 years of age in girls with no secondary sexual characteristics
What are the six causes of primary amenorrhoea?
Turner’s syndrome
Testicular feminisation
Congenital malformations of the genital tract
Anorexia
Congenital adrenal hyperplasia
Imperforate hymen
What is the most common cause of primary amenorrhoea?
Turner’s syndrome
What is Turner’s syndrome?
It is a rare chromosomal disorder affecting females causing the genetic karyotype XO
What are the three clinical features that indicate Turner’s syndrome is the cause of primary amenorrhoea?
Short stature
Short webbed neck
Broad chest with widely spaced nipples
What blood test results indicate that Turner’s syndrome is the cause of primary amenorrhoea?
Elevated FSH
Elevated LH
Low oestrogen
Low testosterone
How do we manage amenorrhoea in individuals with Turner’s syndrome?
Hormone replacement therapy
What is secondary amenorrhoea?
No menstruation for 3-6 months in women with previously normal and regular menses
No menstruation for 6-12 months in women with previous oligomenorrhoea
What are the eight causes of secondary amenorrhoea?
Pregnancy
Hormonal Contraception
Polycystic Ovary Syndrome
Premature Ovarian Failure
Thyroid Disease
Hyperprolactinaemia
Sheehan’s Syndrome
Asherman’s Syndrome
How does hyperprolactinaemia cause secondary amenorrhoea?
The secretion of GnRH is inhibited, which in turn results in low levels of oestrogen
What are the two other clinical features present when hyperprolactinaemia is the cause of secondary amenorrhoea?
Glactorrhoea
Low libido
How does Asherman’s syndrome cause secondary amenorrhoea?
It results in the formation of intrauterine adhesions, which may lead the endometrium to not respond to oestrogen as it normally would
How does Sheehan’s syndrome cause secondary amenorrhoea?
It is a condition in which postpartum blood loss causes ischaemic necrosis of the pituitary gland
This leads to reduced GnRH levels, which causes low levels of oestrogen
What are other clinical feature is present when Sheehan’s syndrome is the cause of secondary amenorrhoea?
Large post-partum haemorrhage
What are the three investigations used to identify the underlying cause of secondary amenorrhoea?
Pregnancy Test
Blood Tests
Ultrasound Scan
