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Gynaecology > Amenorrhoea > Flashcards

Amenorrhoea Flashcards

1
Q

What is primary amenorrhoea

A

No periods until 16 years if sexual secondary characteristics are present.
No periods until age 14 and absence of secondary sexual characteristics

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2
Q

What is secondary amenorrhoea

A

Lack of period occuring after normal menses have begun

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3
Q

What defines amenorrhoea

A

> 6 months between periods

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4
Q

What defines oligomenorrhoea

A

> 6 weeks < 6 months no period

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5
Q

Causes of secondary amenorrhoea

A

Physiological
Drugs
Hypothalamic or pituitary causes
Ovary
OUtflow tract problems
Sex disorders

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6
Q

What physiological conditions can cause amenorrhoea

A

Pregnancy or lactation

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7
Q

Which drugs can cause amenorrhoea

A

Contraceptives or steroids

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8
Q

What hypothalamic conditions can cause amenorrhoea

A

Over exercise, anorexia nervosa, Kallman syndrome and tumours

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9
Q

What pituitary conditions can cause amenorrhoea

A

Adenoma, Sheehan’s syndrome, surgery

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10
Q

Ovarian causes of amenorrhoea

A

PCOS, premature ovarian failure, ovarian dysgenesis (Turners)

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11
Q

What outflow tract problems can cause amenorrhoea

A

Imperforate hymen, transverse vaginal septum, mullerian agenesis - MRKH syndrome

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12
Q

What sex disorders can cause amenorrhoea

A

Androgen insensitivity syndrome and Swyer syndrome

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13
Q

What is the criteria for PCOS

A
  1. Amenorrhoea or oligoamenorrhoea
  2. Clinical signs
  3. Polycystic ovaries on US
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14
Q

What is polycystic ovary syndrome

A

Multifactorial disease causing hyperandrogenism with clinical signs such as hirsutism and acne, with amenorrhoea or oligomenorrhoea

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15
Q

Risk factors for PCOS

A

Maybe genetic - Chr 2 and 9
Environmental factors - south asia has higher prevalence
Obesity
Premature adrenarche

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16
Q

What is the pathophysiology behind the symptoms of PCOS

A

The cause of insulin resistance is from susceptibility to a decrease in glucose tolerance.
Hyperandrogenism is from high testosterone and low SHBG
There is a hormonal imbalance with increase in LH:FSH ratio and decreased FSH secretion. There is no negative feedback of these hormones.

17
Q

Symptoms of PCOS

A

Menstrual irregularity, hirsutism, acne, alopecia, polycystic ovaries, overweight (pre-diabetic)

18
Q

What is classes as polycystic ovaries on US

A

Presence of 12 or more follucles in one or both ovaries +/- increased ovarian volume

19
Q

Associated co-morbidities of PCOS

A

Impaired glucose tolerance
CVD
endometrial cancer
OSA
Infertility
Depression/anxiety
NAFLD
Obesity/metabolic syndrome

20
Q

Investigations into PCOS

A

Total testosterone
Sex-hormone binding globulin (SHBG)
Free androgen levels
+/- pelvis USS
Rule out other causes with - LH, FSH, prolactin and TSH

21
Q

Lifestyle modifications for PCOS

A

Smoking cessation
Calorie restricted diet
Exercise

22
Q

Treatment of oligoamenorrhoea in PCOS

A

Recommended to induce withdrawal bleed every 3-4 months at least, and if there is endometrial thickening the patient should have endometrial sampling. Use POP, COCP, mirena or IUS

23
Q

Treatment of hirsutism

A

COC, finasteride, spironolactone, cyproterone acetate, flutamide, eflornithine, and mechanical methods such as shaving or waxing

24
Q

Treatment of anovolatory infertility

A

Weight loss if BMI >30
Clomiphene citrate
Gonadotrophins
Ovarian drilling
Aromatase inhibitors

25
Q

What is the role of clomiphene citrate in PCOS

A

Inhibits oestrogen receptors at the hypothalamus inhibiting negative feedback of oestrogen on gonadotrophin release leading to up-regulation of the hPG axis

26
Q

What is ovarian drilling

A

The aim is to destroy ovarian androgen producing tissue, 40-50% of total and free testosterone. Indirect modulating effect on pituitary gland and recruitment of new follicles and resumption of normal overian function

27
Q

What is Asherman’s syndrome

A

Where adhesions form within the uterus following damage

28
Q

Presentation of Asherman’s syndrome

A

Presents recently after surgery, endometritis or dilation and curettage. Secondary amenorrhoea, significantly lighter periods, dysmenorrhoea and infertility

29
Q

Diagnosis of Asherman’s syndrome

A

Hysteroscopy, hysterosalpingography, sonohysterography or MRI scan

30
Q

Management of Asherman’s syndrome

A

Dissecting adhesions during hysteroscopy, recurrence is common

31
Q

What are the complications of Asherman’s syndrome

A

Form physical obstructions which distort the pelvis and reuslts in menstruation abnormalities, infertility and recurrent miscarriages

Gynaecology (7 decks)

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