Amenorrhoea

Question 1

What is the definition of primary and secondary amenorrhoea?

Answer 1

Primary: No menstrual bleeding > 16 years
Secondary: Cessation of menstrual bleeding after menses has begun

Question 2

Name 5 causes of primary amenorrhoea

Answer 2

Hypergonadotrophic hypogonadism (high GnRH and FSH/LH, low oestrogen) - Turner's syndrome, 
Hypogonadotrophic hypogonadism (low GnRH, FSH/LH, low oestrogen) - congenital abnormalities (hypopituitism), endocrine disorders (CAH), malignancy, systemic illness, eating disorder
Normal gonadic hormones - anatomical abnormalities (Mullerian abnormalities, cervical atresia), intersex

Question 3

Name 5 causes of secondary amenorrhoea

Answer 3

Physiological - pregnancy, menopause
Iatrogenic - contraception (Mirena), Asherman’s syndrome, chemo/radio
Metabolic - Anorexia, PCOS, hypothyroidism, Cushing’s
Genetic - spontaneous primary ovarian insufficiency, Fragile X
Malignancy, chronic disease

Question 4

Regardless of cause, what is one treatment you could consider for amenorrhoea?

Answer 4

Hormone replacement therapy to prevent osteoporosis