Amenorrhoea Flashcards
What is amenorrhoea?
absence of menstrual periods
What is primary amenorrhoea?
Failure to commence menses in:
− Girls aged 16+ in the presence of secondary sexual characteristics
− Girls aged 14+ in the absence of secondary sexual characteristics
What is secondary amenorrhoea?
cessation of periods for more than 6 months after the menarche
What is oligomenorrhoea?
menstruation every 35 days to 6 months
What can causes of amenorrhoea be divided into?
Hypothalamic Pituitary Adrenal/thyroid gland Ovary Outflow tract
What are the hypothalamic causes of amenorrhoea?
Hypothalamic hypogonadism
Kallmann syndrome
What are the pituitary causes of amenorrhoea?
hyperprolactinaemia
Sheehan’s syndrome-
What are the adrenal/thyroid causes of amenorrhoea?
hypothyroidism leading to raised prolactin and amenorrhoea
androgen insensitivity syndrome
What are the ovarian causes of amenorrhoea?
PCOS (mainly oligomenorrhoea) Premature menopause Ovarian insufficiency/failure Turner's syndrome Gonadal dysgenesis
What are outflow tract problems that cause amenorrhoea?
imperforate hymen vaginal atresia cryptosmenorrhoea/haematocalpos Asherman's syndrome Cervical stenosis
What is hypothalamic hypogonadism?
dysfunction of the ovaries/testes due to dysfunction of the hypothalamus
there is reduced GnRH synthesis and LH and FSH are reduced
What are the causes of hypothalamic hypogonadism?
psychological factors
low weight/anorexia or XS exercise, tumours (uncommon)
What is Kallmann syndrome?
Form of hypothalamic hypogonadism in which there is failure in the correct action of GnRH, there is delayed or absent puberty w absent sense of smell
What is hyperprolactinaemia?
XS prolactin secretion reduces GnRH release
What are the features of hyperprolactinaemia?
galactorrhoea (milky nipple discharge), reduced libido
subfertility
What are the usual causes of hyperprolactinaemia?
pituitary hyperplasia
benign adenoma
What is Sheehan’s syndrome?
Hypopituitarism caused by iichaemic necrosis due to blood loss and hypovolaemic shock during and after childbirth
what is turner’s syndrome?
one X chromosome is absent leading to XO genotype. Short stature and poor secondary sexual characteristics but normal intelligence
What is gonadal dysgenesis?
ovary imperfectly formed due to mosaic abnormalities of the X chromosomes
What is imperforate hymen?
hymen (membrane that partially covers the external vaginal opening) without an opening completely obstructs the vagina, abdominal pain or distension, related to more endometriosis
What is vaginal atresia?
abnormally closed or absent vagina
What is Asherman’s syndrome?
adhesions and fibrosis of the endometrium
What is androgen insensitivity syndrome?
Male has cell receptor insensitivity to androgens
• Androgens are then converted peripherally to oestrogen
Appears female and female external genitalia present, uterus and ovaries are absent and rudimentary testes are present
What are the ix for amenorrhoea?
- Pregnancy - beta hCG
- Serum free androgen index - increased in PCOS
- FSH/LH - low if hypothalamic cause, can be normal if exercise/weight loss, raised if premature menopause
- Prolactin
- MRI scan - pituitary tumour
- TFT
- Testosterone
- TVS - look for uterus
What does a testosterone level of >5nmol/L indicate?
androgen secreting tumour or late onset congenital adrenal hyperplasia
What is the Rx of premature menopause?
natural oestrogen - estradiol
progestogens - levonorgestrel and norethisterone
tibolone
bisphosphonates
What is the Rx of COPC?
→ COCP
→ Dydrogesterone
→ Weight management
→ Clomifene +/- metformin for ovulation and infertility
→ Anti-androgen medication - cyproterone, spironolactone or finasteride (for hirsutism)
→ Laparoscopic ovarian drilling
Rx of hyperprolactinaemia?
dopamine agonist - cabergoline, bromocriptine
surgery if meds fail
