Amenorrhoea

Question 1

What is primary amenorrhoea?

Answer 1

Not starting menstruation by:
13 years when there is no other evidence of pubertal development OR by 15 when there is other evidence of pubertal development

Question 2

What is secondary amenorrhoea?

Answer 2

No menstruation for more than three months after previous regular menstrual periods

Question 3

Primary amenorrhoea (1)
1) What is hypogonadotropic hypogonadism, and this is due to a deficiency of what?
2) What is hypergonadotropic hypogonadism?

Answer 3

1) Deficiency of LH and FSH due to the hypothalamus or pituitary (anterior), leading to deficiency of the sex hormones
2) Gonads fail to respond to stimulation from the gonadotrophins (LH and FSH) leading to high gonadotrophins but low sex hormones (oestrogen and testosterone)

Question 3

Primary amenorrhoea (2)
Name 2 causes of hypogonadotropic hypogonadism

Answer 3

• Hypopituitarism
• Hypothalamus or pituitary damage i.e. radiotherapy or surgery for cancer
• Significant chronic conditions can temporarily delay puberty (i.e. CF or IBD)
• Excessive exercise or dieting can delay the onset of menstruation in girls
• Constitutional delay in growth and development
• Endocrine disorders i.e. GH deficiency, hypothyroidism, Cushing’s or hyperprolactinaemia
• Kallman syndrome

Question 4

Primary amenorrhoea (3)
Name 2 causes of hypergonadotropic hypogonadism

Answer 4

• Previous damage to the gonads (e.g. torsion, cancer or infections such as mumps)
• Congenital absence of the ovaries
• Turner’s syndrome (XO)

Question 5

Secondary amenorrhoea
Name 3 causes

Answer 5

• Pregnancy is the most common cause (!)
• Menopause and premature ovarian failure
• Hormonal contraception
• Hypothalamic or pituitary pathology
• Ovarian causes such as PCOS
• Uterine pathology i.e. Asherman’s syndrome
• Thyroid pathology
• Hyperprolactinaemia i.e. prolactinoma
• Excessive exercise
• Low body weight and eating disorders
• Chronic disease
• Psychological stress
• Pituitary failure