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LMCC Study - OBGYN > Amenorrhoea > Flashcards

Amenorrhoea Flashcards

1
Q

What are the two different types of amenorrhea?

A

1) Primary: Menstruation has never occured

2) Secondary: Menstruation was established and then ceases for 6+ months

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2
Q

At what age would you consider someone to have primary amenorrhea? (hint: two ages depending on circumstances)

A

1) 15 years old if development of secondary sexual characteristics is present
2) 13 years old if no development of secondary sexual characteristics

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3
Q

What are the two main anatomical causes for primary amenorrhea?

A

1) Congenital abscence of uterus (failed development of mullerian ducts)
2) Imperforate hymen (blood retained within the vagina)

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4
Q

What is a progesterone challenge test?

A

A progestogen is given orally for 5 days and then stopped, bleeding should occur due to withdrawal in normal tests
Test for estrogenation

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5
Q

How long must a patient have no menstruation before they are considered to have secondary amenorrhea?

A
  • 6 months in the absence of pregnancy
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6
Q

What are the three most common causes of secondary amenorrhea?

A
  • Weight loss
  • Polycystic ovarian syndrome (PCOS)
  • Hyperprolactinoma
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7
Q

What are the most common causes of amenorrhea during a womans reproductive years?

A
  • Pregnancy
  • Lactation
    Ensure you rule these out in any pt complaining of amenorrhea
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8
Q

What is the pathophysiology behind lactational amenorrhea?

A
  • High postpartum prolactin production

- Prolactin is inhibitory to secretion of gonadotrophins

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9
Q

Physical and emotional stress can lead to amenorrhea by which mechanism?

A
  • Suppression of the hypothalamic-pituitary-ovarian axis

- leading to low pituitary gonadotrophins in association with low prolactin and estrogen

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10
Q

Aside from amenorrhea, what other symptom may someone have if high prolactin levels were causing their amenorrhea?

A
  • Galactorrhea
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11
Q

Bitemporal hemianopia in a pt with amenorrhea will lead you to suspect what diagnosis?

A
  • Pituitary adenoma

- Increased prolactin from pituitary (large pituitary putting pressure on optic chiasm)

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12
Q

What is premature ovarian failure?

A
  • The term used to describe the cessation of ovarian function before the age of 40
  • As in menopause the failure is typically due to depletion of premordial follicles
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13
Q

What are the criteria for polycystic ovarian syndrome (PCOS)

A

At least two of the following three:

  • Oligo/Amenorrhea
  • Clinical evidence of excess androgen (acne, hirsutism, of biochemical evidence -ie raised Test)
  • U/S appearance of large volume ovaries (>10cm3) and/or multiple small follicles (12+ that are under 12mm)
    • Ruled out other causes of amenorrhea and hyperandrogenism **
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14
Q

With PCOS there are 3 typical presenting problems all of which can alter treatment what are they?

A

1) Menstrual irregularities
2) Hirsutism
3) Infertility

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15
Q

How can you treat menstrual irregularities in PCOS?

A
  • OCP
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16
Q

How can you treat hirsutism in PCOS?

A
  • Combined OCP can suppress ovarian androgen production
  • Waxing and other cosmetic procedures
  • Anti-androgen medication (Cyproterone acetate) - in Diane 35, spironolactone
17
Q

Women taking anti-androgen medication should use contraception during and for 3 months following discontinuation. How come?

A
  • Potential risk of teratogenicity, specifically feminization of a male fetus
18
Q

How can you treat infertility in PCOS?

A
  • Weight reduction in cornerstone treatment
  • Insulin sensitizing agents like metformin (questionable benefit)
  • medical induction of ovulation (using anti estrogen medication)
19
Q

Long term, patients with PCOS are at increased risk for which conditions?

A
  • Endometrial hyperplasia and carcinoma (due to anovulation and unopposed estrogen)
  • T2DM
  • Cardiovascular disease
  • HTN
  • Lipids
  • Vascular disease
20
Q

How can thyroid problems cause amenorrhea?

A
  • Thyrotoxicosis: High serum sex hormine binding globulin results in hormonal changes causing anovulation
  • Hypothyroidism: Increased thyrotrophin-releasing hormone stimulates prolactin production which inhibits gonadotrophs
21
Q

What is asherman syndrome (AKA Fritsch or Fritsch-Asherman syndrome)?

A
  • Occurs due to excessive curettage
  • The basal layer of endometrium is inadvertantly removed resulting in adhesions which block menstrual flow
  • Interesting point: Endometrial ablation is essentially medically inducing asherman syndrome*
22
Q

What is Sheehan syndrome?

A
  • Post partum pituitary necrosis causing hypopituitarism.

- Occurs following post-partum hemorrhage leading to hypovolemic shock and ischemic necrosis of pituitary.

23
Q

What are the pituitary hormones (7) that would be affected by Sheehan syndrome

A

FLAGTOP

  • Follicle stimulating hormone
  • Luteinizing hormone
  • Adrenocorticotropic hormone (ACTH)
  • Growth hormone
  • Thyroid stimulating hormone
  • melanOcyte stimulating hormone
  • Prolactin
24
Q

The LH to FSH ratio expected in PCOS is what?

A
  • Greater than 2:1

- LH chronically high with FSH mid range to low

25
Q

Which tests will you order when working up PCOS?

A
  • DHEA-S
  • Androstenedione
  • Free testosterone (most sensitive)
  • Test for insulin resistance
  • FSH and LH for ratio greater than 2:1

LMCC Study - OBGYN (21 decks)

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