Amenorrhoea

Question 1

Define

Q’s to ask yourself

Answer 1

No periods

Any external 2* characteristics?
Is internal genitalia normal?

Question 2

Primary Amenorrhoea:

Define

Genetic diseases that can cause this?

How may it be diagnosed?

Answer 2

Failure to start periods

Turner’s syndrome
Fragile X syndrome
Androgen insensitivity syndrome

Karyotyping

Question 3

Secondary Amenorrhoea:

Define

It is usually due to disruption to the HPO axis can cause this. List 4 things that can cause this?

Other causes:

• Why can severe hyperthyroidism cause this?
• Asherman’s syndrome - What does it cause leading to 2* A?
• What may be something asymptomatic but usually happens a lot later?
• 3 ovarian causes
• Pregnancy-related? - 2

Answer 3

Periods stop for more than 6 months/yr

Stress
Pituitary tumour
Over exercise and weight loss
Anorexia

An increase in thyroid hormone indirectly causes an increase in sex hormone-binding globulin (SHBG), which can prevent ovulation.

Adhesions in the uterus

Early menopause

PCOS
Ovarian insufficiency syndrome
Tumour

Post-pregnancy
Breastfeeding

Question 4

WHAT SHOULD YOU RULE OUT BEFORE EVEN INVESTIGATING??

Answer 4

Pregnancy - measure Beta - hCG

Question 5

1* - Investigations:

What needs to be examined?

What type of testing test needs to be done?

Answer 5

Examine external genitalia

Consider karyotype testing

Question 6

2* - Investigations:

What does raised LH and testosterone suggest?

What does raised LH and FSH suggest?

What does a low LH and FSH suggest?

Why can hormone can you measure if you suspect PCOS?

What hormone may increase due to stress, hypothyroidism and a PITUITARY TUMOUR?

What hormone needs to be measured for thyroid disease?

What hormone may suggest an androgen-secreting tumour?

Answer 6

PCOS

Ovarian failure (inc. premature menopause)

Hypothalamic dysfunction (e.g. excess exercise)

Androgens

Prolactin - MRI needs to be done to rule out a tumour

TFT’s - TSH

Testosterone

Question 7

Management:

Treat underlying cause basically
Advice on diet, exercise, stress etc.

What Rx can be done for menopause?

If 2* A due to contraception and the patient is having mild cyclical dysfunction, what can be used to restore the cycle?

What can be given for an axis that is completely shut down?

Answer 7

HRT

Clomifene

Gonadotropin-releasing hormones

Question 8

Causes of ovarian insufficiency/failure - 2

Answer 8

Secondary to chemo, radiotherapy and surgery

Genetic disorders - Turner’s

Question 9

Oligomenorrhoea:

Define

Causes - 2

Answer 9

Infrequent periods

PCOS
Extremes of reproductive life