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Women's Health > Amenorrhoea > Flashcards

Amenorrhoea Flashcards

1
Q

What is amenorrhoea?

A

absence of menstrual periods

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2
Q

What is primary amenorrhoea?

A

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

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3
Q

What is secondary amenorrhoea?

A

cessation of periods for more than 6 months after the menarche

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4
Q

What is oligomenorrhoea?

A

menstruation every 35 days to 6 months

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5
Q

What can causes of amenorrhoea be divided into?

A 
Hypothalamic
Pituitary 
Adrenal/thyroid gland 
Ovary 
Outflow tract
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6
Q

What are the hypothalamic causes of amenorrhoea?

A

Hypothalamic hypogonadism

Kallmann syndrome

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7
Q

What are the pituitary causes of amenorrhoea?

A

hyperprolactinaemia

Sheehan’s syndrome-

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8
Q

What are the adrenal/thyroid causes of amenorrhoea?

A

hypothyroidism leading to raised prolactin and amenorrhoea

androgen insensitivity syndrome

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9
Q

What are the ovarian causes of amenorrhoea?

A 
PCOS (mainly oligomenorrhoea)
Premature menopause
Ovarian insufficiency/failure 
Turner's syndrome
Gonadal dysgenesis
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10
Q

What are outflow tract problems that cause amenorrhoea?

A 
imperforate hymen
vaginal atresia
cryptosmenorrhoea/haematocalpos
Asherman's syndrome
Cervical stenosis
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11
Q

What is hypothalamic hypogonadism?

A

dysfunction of the ovaries/testes due to dysfunction of the hypothalamus
there is reduced GnRH synthesis and LH and FSH are reduced

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12
Q

What are the causes of hypothalamic hypogonadism?

A

psychological factors

low weight/anorexia or XS exercise, tumours (uncommon)

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13
Q

What is Kallmann syndrome?

A

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

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14
Q

What is hyperprolactinaemia?

A

XS prolactin secretion reduces GnRH release

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15
Q

What are the features of hyperprolactinaemia?

A

galactorrhoea (milky nipple discharge), reduced libido

subfertility

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16
Q

What are the usual causes of hyperprolactinaemia?

A

pituitary hyperplasia

benign adenoma

17
Q

What is Sheehan’s syndrome?

A

Hypopituitarism caused by iichaemic necrosis due to blood loss and hypovolaemic shock during and after childbirth

18
Q

what is turner’s syndrome?

A

one X chromosome is absent leading to XO genotype. Short stature and poor secondary sexual characteristics but normal intelligence

19
Q

What is gonadal dysgenesis?

A

ovary imperfectly formed due to mosaic abnormalities of the X chromosomes

20
Q

What is imperforate hymen?

A

hymen (membrane that partially covers the external vaginal opening) without an opening completely obstructs the vagina, abdominal pain or distension, related to more endometriosis

21
Q

What is vaginal atresia?

A

abnormally closed or absent vagina

22
Q

What is Asherman’s syndrome?

A

adhesions and fibrosis of the endometrium

23
Q

What is androgen insensitivity syndrome?

A

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

24
Q

What are the ix for amenorrhoea?

A
  1. Pregnancy - beta hCG
  2. Serum free androgen index - increased in PCOS
  3. FSH/LH - low if hypothalamic cause, can be normal if exercise/weight loss, raised if premature menopause
  4. Prolactin
  5. MRI scan - pituitary tumour
  6. TFT
  7. Testosterone
  8. TVS - look for uterus
25
Q

What does a testosterone level of >5nmol/L indicate?

A

androgen secreting tumour or late onset congenital adrenal hyperplasia

26
Q

What is the Rx of premature menopause?

A

natural oestrogen - estradiol
progestogens - levonorgestrel and norethisterone
tibolone
bisphosphonates

27
Q

What is the Rx of COPC?

A

→ COCP
→ Dydrogesterone
→ Weight management
→ Clomifene +/- metformin for ovulation and infertility
→ Anti-androgen medication - cyproterone, spironolactone or finasteride (for hirsutism)
→ Laparoscopic ovarian drilling

28
Q

Rx of hyperprolactinaemia?

A

dopamine agonist - cabergoline, bromocriptine

surgery if meds fail

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