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Year 4 Gynae > Amenorrhoea > Flashcards

Amenorrhoea Flashcards

1
Q

Causes of primary amenorrhoea

A 
Turners syndrome 
Imperforate hymen 
Hyperandrogenism - congenital adrenal hyperplasia
delayed puberty 
Mullerian agenesis  
Low BMI
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2
Q

Causes of secondary amenorrhoea

A 
Pregnancy Contraception 
Sheehan's syndrome 
Stress - BMI/ exercise
Hyperthyroidism 
PCOS
Prolactinoma
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3
Q

Investigations of amenorrhoea

A

Bloods - TFTs, FSH, LH, androgens, oestrogen, prolactin
USS
Karyotyping

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4
Q

Oligomenorrhoea definition

A

The duration between cycles is more than 35 days but less than 6 months

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5
Q

Secondary amenorrhoea

A

Not had a period after 3 months if cycles were normally regular or 6 months if irregular with oligomenorrhoea

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6
Q

Investigations for secondary amenorrhoea

A

Pregnancy test
Bloods - FSH, TSH, Prolactin

FSH normal:
- USS

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7
Q

Definition of primary amenorrhoea

A

Not starting menstruation by:

  • 13 years with no evidence of pubertal development

OR

By 15 yo where there are other signs of puberty

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8
Q

When should normal puberty occur

A

Age 8 – 14 in girls

Age 9 – 15 in boys

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9
Q

Female puberty

A
  1. Breast buds - thelarche
  2. Pubic hair
  3. Menarche
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10
Q

Types of hypogonadism

A
  • Hypogonadotropic hypogonadism

- Hypergonadotropic hypogonadism

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11
Q

Hypogonadotropic hypogonadism

A

Deficiency of LH and FSH released from the pituitary gland

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12
Q

Hypergonadotropic hypogonadism

A

Lack of response to LH and FSH by the gonads (the testes and ovaries)

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13
Q

Causes of hypogonadotropic hypogonadism

A

Hypopituitarism

Damage to the hypothalamus/ pituitary - radiotherapy/ surgery

Chronic conditions can temporarily delay puberty (e.g. cystic fibrosis or inflammatory bowel disease)

Excessive exercise or dieting

Constitutional delay in growth and development

Growth hormone deficiency, hypothyroidism, Cushing’s or hyperprolactinaemia

Kallman syndrome

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14
Q

Causes of hypergonadotropic hypogonadism

A

Previous damage to the gonads (e.g. torsion, cancer or infections such as mumps)

Congenital absence of the ovaries

Turner’s syndrome (XO)

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15
Q

Kallman syndrome

A

Pubertal delay and anosmia

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16
Q

Congenital adrenal hyperplasia pathophysiology

A

Congenital deficiency of the 21-hydroxylase enzyme.

Causing an underproduction of cortisol and aldosterone, and overproduction of androgens from birth

17
Q

Inheritance pattern of congenital adrenal hyperplasia

A

Autosomal recessive

18
Q

Presentation of congenital adrenal hyperplasia

A

Tall for their age

Facial hair

Absent periods (primary amenorrhoea)

Deep voice

Early puberty

19
Q

Androgen Insensitivity Syndrome pathophysiology

A

Tissues are unable to respond to androgen hormones (testosterone)

20
Q

Presentation of androgen insensitivity syndrome

A

Female phenotype - female external genitalia and breast tissue with male internal sexual organs (testes)

21
Q

Types of structural pathology

A

Imperforate hymen

Transverse vaginal septae

Vaginal agenesis

Absent uterus

Female genital mutilation

22
Q

Investigations for primary amenorrhoea

A

Bloods:

  • FBC, ferritin -anaemia
  • U&E - CKD
  • Anti-TTG or anti-EMA antibodies -coeliac disease
  • TFTs
  • Insulin-like growth factor I - screening test for GH deficiency

Hormonal blood tests assess

Genetic testing with a microarray test

Imaging

23
Q

Hormonal blood tests for primary amenorrhoea

A

FSH and LH will be low in hypogonadotropic hypogonadism

High in hypergonadotropic hypogonadism

Prolactin -hyperprolactinaemia

Testosterone - PCOS, androgen insensitivity syndrome and congenital adrenal hyperplasia

24
Q

Genetic testing with a microarray test

A

Turner’s syndrome (XO)

25
Q

Imaging for primary amenorrhoea

A

Xray of the wrist -bone age for constitutional delay

Pelvic USS - assess the ovaries and other pelvic organs

MRI - pituitary pathology and assess the olfactory bulbs in Kallman syndrome

26
Q

How to treat hypogonadotrophic hypogonadism

A

Pulsatile GnRH

27
Q

How to treat primary amenorrhoea due to stress

A

Reduction in stress:

  • CBT
  • healthy weight gain
28
Q

How to treat constitutional delay in growth and development

A

Reassurance and observation

29
Q

Treatment for hyperprolactinaemia

A

Dopamine agonists -bromocriptine or cabergoline

30
Q

Investigations for hyperprolactinaemia

A

Bloods - prolactin

MRI scan - pituitary adenoma

31
Q

Why do women with PCOS have a withdrawal bleed every 3 - 4 months

A

Reduce the risk of endometrial hyperplasia and endometrial cancer

32
Q

Complications of amenorrhoea

A

Amenorrhoea associated with low oestrogen -increased risk of osteoporosis.

Where the amenorrhoea lasts more than 12 months, treatment is indicated to reduce the risk of osteoporosis:

Ensure adequate vitamin D and calcium intake
Hormone replacement therapy or the combined oral contraceptive pill

33
Q

When to reduce risk of amenorrhoea related osteoporosis

A

Amenorrhoea lasting 12 months + :

  • Adequate vitamin D and calcium intake
  • Hormone replacement therapy or the COCP

Year 4 Gynae (35 decks)

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