Amenorrhoea Flashcards
Causes of primary amenorrhoea?
Constitutional delay
Structural causes
Genetic causes - eg Turners, Kallman’s
Iatrogenic - chemoradiation
What is the average age of onset of periods?
12, 16 at the latest
In what order do the characteristics of puberty arise?
Adrenarchy
Growth spurt
Breast buds
Menarche
When do you investigate delayed menarche prior to 16?
When they’re are no other sexual characteristics eg breast buds
Family history
How does imperforate hymen present?
Cyclic pain and cramping
Bulging blue membrane at introitus
Build up of products in vagina on US
When don’t you have a uterus?
XY karyotype - androgen insensitivity syndrome - female phenotype
XX karyotype - MRKH syndrome
What are some genetic causes of primary amenorrhoea?
Androgen insensitivity syndrome
MRKH syndrome
Kallman’s
How do you investigate primary amenorrhoea?
bHCG Oestrogen, LH, FSH Free androgen index AMH Karyotype Pelvic US - structural problem Bone age
Causes of secondary amenorrhoea in order of incidence?
Pregnancy PCOS Menopause Hypothalamic amenorrhoea Hyperprolactinaemia Premature ovarian insufficiency
What is secondary amenorrhoea?
Loss of periods for 6 six months after menarche
What do FSH findings reflect?
Normal PCOS
High - Ovarian insufficiency
Low - Hypothalamic cause
When is galactorrhea a poor sign?
In women who’ve had children
What needs to be managed in PCOS?
Hyperandrogenism
Fertility
Endometrial hyperplasia
Metabolic disease
How do you protect the endometrium in PCOS?
Sequential endometrial withdrawal bleed
Use the pill or mirena
How does the presence/absence of secondary sexual characteristics indicate diagnosis in primary amenorrhoea?
If present: A anatomical abnormalities more like eg absent uterus, imperforate hymen
If absence: indicates genetic disorder, primary gonadal failure or central failure of gonadotrophin release
