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Obs and Gyne > Amenorrhoea > Flashcards

Amenorrhoea Flashcards

1
Q

What is primary amenorrhoea?

A

No periods:

  • <16 if secondary sexual characteristics present
  • <14 if no secondary sexual characteristics
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2
Q

What is secondary amenorrhoea?

A

Menstruation previously occurred but stopped >6 months

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3
Q

What are the causes of primary amenorrhoea when secondary sexual characteristics are present? (5)

A
  • Constitutional Delay
  • Genitourinary malformation
  • Androgen resistance syndrome (XY karyotype)
  • Hyperprolactinaemia
  • Pregnancy
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4
Q

What are the causes of primary amenorrhoea when secondary sexual characteristics are absent? (3)

A
  • Ovarian failure
  • Hypothalmic failure
  • HPA axis failure
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5
Q

What are the causes of ovarian failure? (4)

A
  • Chemo
  • Radiation
  • Chromosomal gonadal abnormality (turners)
  • Developmental abnormality (Mullerian agenesis)
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6
Q

What are the causes of hypothalmic failure?

A
  • Chronic illness
  • Excessive exercise
  • Stress
  • Significantly underweight
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7
Q

What are the causes of HPA axis failure?

A
  • Tumours /irradiation/ infection/ head injury inv. hypothalmus or pituitary
  • Kallmanns syndrome
  • Prader willi syndrome
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8
Q

What are the features of Kallmanns syndrome?

A

Delayed or absent puberty + impaired sense of smell

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9
Q

What causes Kallmanns syndrome?

A

Hypogonadatropic hypogonadism - impairment of hypothalamus to release GnRH

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10
Q

Which hormone is lacking in Kallmanns syndrome?

A

GnRH

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11
Q

What are the causes of secondary amenorrhoea when there are no signs of androgen excess?

A
  • Pregnancy/lactation/menopause
  • Premature ovarian failure
  • Progesterone contraception
  • Weight loss
  • Pituitary disease/hyperprolactinaemia
  • Thyroid disease
  • Iatrogenic (medications, surgery, irradiation, chemo)
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12
Q

What are features of androgen excess? (3)

A

Hair growth
Acne
Development of male characteristics

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13
Q

What are the causes of secondary amenorrhoea when there are signs of androgen excess?

A
  • PCOS
  • Cushing’s
  • Adrenal/ovarian carcinoma
  • Late onset congenital adrenal hyperplasia
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14
Q

What would an FSH > 20 suggest in a pt with amenorrhoea?

A

Premature menopause

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15
Q

What would a low FSH and LH suggest in a pt with amenorrhoea?

A

Hypothalamic-pituitary cause of amenorrhoea

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16
Q

What would an increased prolactin suggest?

A

Stress
Hypothyroidism
Prolactinoma
Drugs

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17
Q

What drugs (and indications) cause an increased prolactin? (3)

A

Phenothiazines (antipsychotic)
Domperidone (antiemetic)
Metoclopramide (nausea/vomiting)

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18
Q

What would a testosterone >5 suggest? (2)

A

Androgen secreting tumour

Late onset congenital adrenal hyperplasia

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19
Q

What are the Rotterdam criteria?

A

2/3 to diagnose PCOS:
Polycystic ovaries on US
Oligo-ovulation or anovulation
Clinical/biochemical Signs of hyperandrogenism

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20
Q

What causes darkened skin (acanthosis nigricans) in PCOS?

A

Hyperinsulinaemia

21
Q

What is the management of PCOS? (5)

A
  • Weight loss (increases insulin sensitivity)
  • Metformin (increases insulin sensitivity)
  • Clomifene citrate (induce ovulation to conceive)
  • Ovarian drilling if not responding to Clomifene
  • COCP (control bleeding)
22
Q

What are the long term consequences of PCOS? (4)

A
  • Gestational diabetes
  • T2DM
  • Cardiovascular disease
  • Endometrial cancer
23
Q

What are the causes of menorrhagia?

A
  • Dysfunctional uterine bleeding (diagnosis of exclusion)
  • Copper coil
  • Fibroids
  • Endometriosis
  • Adenomyosis
  • Pelvic infection
  • Polyps
  • Endometrial carcinoma
    Other:
  • Hypothyroidism
  • Caogulation disorder
24
Q

What would an enlarged uterus on examination suggest?

A

Fibroids or adenomyosis

25
Q

What should you do if there is inter-menstrual bleeding or post-coital bleeding

A

Check smear history

26
Q

In a 48 year old patient with menorrhagia who has failed medical therapy, what investigations are needed?

A

Transvaginal US
Endometrial biopsy
Outpatient hysteroscopy

27
Q

What is the 1st line treatment of menorrhagia?

A

Mirena IUS

28
Q

What are the management options for menorrhagia?

A 
Drugs
- Mirena
- Tranexamic acid
- Mefenamic acid
- COCP
- Progestogens IM
Surgery
- Endometrial ablation
- Uterine artery embolisation
- Myometomy
- Hysterectomy
29
Q

What is the average age of menopause in the UK?

A

52

30
Q

What symptoms do women going through the menopause experience?

A

Menstrual irregualrity
Vasomotor disturbance (sweats, palpitations, flushes)
Atrophy of genitalia, breasts and skin
Osteoporosis

31
Q

What type of HRT should be given to women without a uterus?

A

Oestrogen only

32
Q

What type of HRT should be given to women with a uterus who have had a period in the last 12 months?

A

Oestrogen and cyclical progesterone

33
Q

What type of HRT should be given to women with a uterus who have not had a period in the last 12 months?

A

Continuous combined HRT

34
Q

What are contraindications to HRT?

A 
Oestrogen dependent cancer
Past PE
Undiagnosed PV bleeding
High LFTs
Pregnancy
Breast feeding
Phlebitis
35
Q

What are fibroids?

A

Benign smooth tumours of the uterus

36
Q

What percentage of women of reproductive age have fibroids?

A

20-40%

37
Q

Wha are the risk factors for fibroids?

A

Increasing age
Afro-carribean
FH of fibroids

38
Q

What other diseases are associated with fibroids?

A

Skin and uterine leiomyomata

Renal cell cancer

39
Q

How and why does pregnancy affect fibroids?

A

Enlarge in pregnancy as they are oestrogen dependent

also COCP

40
Q

When do fibroids atrophy?

A

After menopause

41
Q

How can fibroids present?

A 
Asymptomatic
Menorrhagia
Fertility problems 
Pain
Mass
42
Q

How do fibroids affect periods?

A

Menorrhagia

Not IMB/PMB

43
Q

Why do fibroids cause fertility problems?

A

Submucosal fibroids interfere with implatation

44
Q

When do fibroids cause pain?

A

Torsion of a pedunculated fibroid

Or thrombosis of the blood supply (red degeneration)

45
Q

What symptoms may come up in a systems review in a patient with fibroids?

A

Large fibroids may cause:

  • increased urinary frequency (bladder)
  • Oedematous legs/varicous veins (veins)
46
Q

What are the medical treatment options for fibroids?

A

GnRH analogues
- goserelin SC monthly for 3-6 months prior to surgery to shrink fibroids
Ullipristal acetate
- Selective progesterone receptor modulator
- Taken daily for 3-6 months to shrink fibroids and induce amenorrhoea prior to surgery

47
Q

What are the surgical treatment options for fibroids?

A 
Myomectomy
- hysteroscopic
- laparoscopic
- open
Uterine artery embolisation
Hysterectomy
48
Q

What is red degeneration of fibroids?

A

Thrombosis of capsular vessels, followed by venous engorgement and inflammation
Causes abdo pain and localised peritoneal tenderness

49
Q

How do you treat red degeneration of fibroids?

A

Bed rest and analgesia
Should resolve over 4-7 days
Plan C-section if large masses of fibroids are noted

Obs and Gyne (9 decks)

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