Amenorrhoea

Question 1

Primary amenorrhoea

Answer 1

absence of menstruation by 16 years of age

Question 2

Secondary amenorrhoea

Answer 2

absence of menstruation for more than 6 months in a normal female of reproductive age which is not due to;
- Pregnancy, lactation or menopause

Question 3

Anatomical causes of amenorrhea

Answer 3

1. Genital tract abnormality
2. Asherman’s syndrome - intra uterine adhesions preventing menstruation
3. Mullerian agenesis - congenital malformation where mullerian ducts fail to develop

Question 4

Ovarian causes of amenorrhea

Answer 4

1. PCOS - annovulation

2 Premature ovarian failure

Question 5

Premature ovarian failure

Answer 5

defined as cessation of periods before 40

Question 6

Pituitary disorders

Answer 6

1. Adenomas of the pituitary gland - prolactinomas are the most common
2. Pituitary necrosis - Sheehan’s syndrome

Question 7

Other conditions causing amenorrhea

Answer 7

1. Kallman’s syndrome

2. Systemic disorders e.g. sarcoidosis, tuberculosis

Question 8

Ix of amenorrhoea

Answer 8

1. Pregnancy test

2. Bloods for LH, FSH, testosterone, prolactin testing

Question 9

Results show raised LH or testosterone, this suggests cause is…

Answer 9

Polycystic ovarian syndrome

Question 10

Results show raised FSH

Answer 10

Suggestive of Premature ovarian failure

Question 11

Results show high prolactin

Answer 11

Prolactinoma

Question 12

Ultrasound scan

Answer 12

Check for poly cysts on the ovaries

Question 13

When may hysteroscopy be indicated?

Answer 13

Where Asherman’s or Cervical stenosis is indicated

Question 14

Tx for Hyperprolactinaemia due to prolactinoma

Answer 14

Dopamine agonist - bromocriptine

Question 15

Tx for Asherman’s

Answer 15

1. Adhesiolysis and IUD insertion

Question 16

Tx for cervical stensosis

Answer 16

Hysteroscopy and cervical dilatation

Question 17

If past surgical history is evacuation of the uterus, the cause is likely to be

Answer 17

Asherman’s syndrome

Question 18

Hirisutism and infertility background, the cause is likely to be..

Answer 18

PCOS

Question 19

Causes of secondary amenorrhea

Answer 19

SOAP

1. Stress
2. OCP
3. Anorexia
4. Pregnancy

Question 20

ASHERMAN’S SYNDROME FEATURES

Answer 20

Acquired anomaly
Secondary to surgery
Hysteroscopy
Endometrial damage
Repeated uterine trauma
Missed menses
Adhesions
Normal LH,FSH etc