Amenorrhoea

Question 1

amenorrhoea definition?

Answer 1

absence of menstruation for >6 months

Question 2

2 types of amenorrhoea?

Answer 2

primary (never menstruated by age 16)

secondary ( absence for >6 months in women who has previously menstruated)

Question 3

what can cause primary amenorrhoea?

Answer 3

genital tract abnormalities
mullerian agenesis
premature ovarian failure/premature ovarian insufficiency
genetic causes
hypothalamic disorders
iatrogenic
autoimmune destruction
endocrine causes
pituitary disorders

Question 4

examples of genetic tract abnormalities?

Answer 4

imperforate hymen
vaginal agenesis or septa
cervical stenosis

Question 5

what is mullerian agenesis?

Answer 5

congenital malformation where the mullerian ducts fail to develop resulting in absent uterus and variable malformations of the vagina

Question 6

what is premature ovarian failure?

Answer 6

cessation of periods before the age of 40

can be due to chemotherapy, radiotherapy, autoimmune disorders or turners syndrome etc

Question 7

genetic causes of primary amenorrhoea?

Answer 7

turners syndrome
pure gonadal agenesis
androgen insensitivity syndrome
5-alpha reductase deficiency

Question 8

what hypothalamic disorders can cause primary amenorrhoea?

Answer 8

kallmans syndrome (absence or failure to respond to GnRH)

Question 9

endocrine causes of primary amenorrhoea?

Answer 9

hypothyroidism
constitutional delay
congenital adrenal hyperplasia
PCOS
androgen secreting tumour

Question 10

what pituitary disorders can cause primary amenorrhoea?

Answer 10

adenoma
prolactinoma
infiltrative disease (sarcoidosis)

Question 11

how might a patient with primary amenorrhoea present?

Answer 11

no periods but still have secondary sexual characteristics

distended uterus or vagina filled with blood on US

Question 12

what can cause secondary amenorrhoea?

Answer 12

hypothalamic disorders
autoimmune conditions
pituitary disorders
iatrogenic 
endocrine abnormalities
ashermanns syndrome
other uterine problems
physiological causes

Question 13

what hypothalamic disorder can cause secondary amenorrhoea?

Answer 13

excessive exercise
weight loss
stress
systemic disorders such as sarcoidosis

Question 14

what pituitary disorders can cause secondary amenorrhoea?

Answer 14

sheehan syndrome
hyperprolactinaemia
haemochromatosis

Question 15

iatrogenic causes of secondary amenorrhoea?

Answer 15

oophrectomy
radiation
chemo
antidopaminergic drugs

Question 16

endocrine causes of secondary amenorrhoea?

Answer 16

hypothyroid
hyperthyroid
PCOS

Question 17

what is ashermann syndrome?

Answer 17

acquired condition that occurs when adhesions form inside the uterus
it prevents menstruation and causes other menstrual disturbances, reduced fertility and placental abnormalities

Question 18

what other uterine problems can cause secondary amenorrhoea?

Answer 18

endometrial atrophy

cervical stenosis from aggressive treatment for cervical cancer

Question 19

how is amenorrhoea managed?

Answer 19

history and exam
assess BMI and secondary sexual characteristics
look for signs of endocrine disturbance
additional tests such as visual fields if pituitary problem suspected
examine external genitalia
exclude pregnancy