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Obstetrics and gynaecology > Amenorrhoea and oligomenorrhoea > Flashcards

Amenorrhoea and oligomenorrhoea Flashcards

1
Q

Describe amenorrhoea

A

The absence of menstrual periods

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2
Q

What is primary amenorrhoea?

A

Failure to commence menses (absence of menarche)

  • girls aged >16 in presence of secondary sexual characteristics
  • girls aged >14 in the absence of sexual characteristics
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3
Q

What is secondary amenorrhoea?

A

cessation of periods for more than 6 months after the menarche - after excluding pregnancy

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4
Q

What is oligomenorrhoea?

A

Irregular periods with intervals between menstrual cycles of more than 35 days and or less than nine periods per year

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5
Q

Describe the hypothalamic pituitary axis?

A

Hypothalamus - GnRH anterior pituitary

  • FSH - granulosa cells - inhibin
  • LH- theca cells -androgens
  • oestrogen which feeds back to stimulate hypothalamus and anterior pituitary
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6
Q

List some causes of hypothalamic amenorrhoea

A

Functional disorders
Severe chronic conditions
Kallmann syndrome

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7
Q

List some functional disorders causing hypothalamic amenorrhoea

A

Eating disorders

High levels of exercise

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8
Q

Describe how functional disorders result in hypothalamic amenorrhoea

A

Suppress GnRH production and subsequently lead to low oestradiol levels via ghrelin and leptin

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9
Q

Name some severe chronic conditions which could cause a hypothalamic amenorrhoea

A

Psychiatric disorders
Thyroid disorders
Sarcoidosis

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10
Q

What is Kallmann syndrome?

A

X-linked recessive disorder characterised by failure of migration of GnRH cells

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11
Q

Which hormones does the anterior pituitary release?

A

LH

FSH

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12
Q

List some causes of pituitary amenorrhoea

A

Pituitary tumours/prolactinomas

Sheehans syndrome

Destruciton of pituitary gland

Post contraception amenorrhoea

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13
Q

What percentage of all pituitary tumours are prolactinomas?

A

40-50%

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14
Q

Describe how prolactinomas result in amenorrhoea

A

Secrete high levels of prolactin which suppresses GnRH secretion

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15
Q

Other than amenorrhoea, which 2 other problems can prolactinomas cause?

A

Anovulation

Galactorrhoea

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16
Q

What is Sheehan’s syndrome?

A

Post-partum pituitary necrosis secondary to massive obstetric haemorrhage resulting in pituitary hormone deficiency

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17
Q

How can the pituitary gland become damaged?

A

Tumour
Post partum necrosis
Radiation
Autoimmune disease

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18
Q

Describe post-contraception amenorrhoea

A

Prolonged use of contraceptives can cause long term downregulation of the pituitary gland and irregular/absent periods or lack of ovulation which persists

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19
Q

Which contraceptive is most associated with post-contraception amenorrhoea?

A

Depo-Provera

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20
Q

How long after Depo-Provera can it take for menses to resume?

A

18 months

21
Q

List some ovarian causes of amenorrhoea

A

Polycystic ovarian syndrome

Turner’s syndrome

Premature ovarian failure

22
Q

Describe PCOS

A

High levels of androgens

23
Q

Describe Turner’s syndrome

A

45 XO - a genetic condition that causes amenorrhoea, failure to develop secondary sexual characteristics and almost universal infertility
Other features include short statue, webbed neck and coarctation of the aorta

24
Q

Describe premature ovarian failure

A

<40yrs
primary ovarian insufficiency
Hot sweats or night sweats

25
Q

What blood hormone picture is seen in a case of premature ovarian failure?

A

Low oestrogen and high FSH

26
Q

What is an adrenal condition that can affect ovulation?

A

Late onset/mild congenital adrenal hyperplasia

27
Q

Describe late onset/mild adrenal hyperplasia

A

Autosomal recessive inherited condition which is caused by partial deficiency of 21 hydroxylase

28
Q

What is 21-hydroxylase used for?

A

Synthesis of cortisol and aldosterone

29
Q

Describe the clinical presentation of late onset/mild adrenal hyperplasia

A

Early development of pubic hair
Irregular/absent periods
Hirsutism
Acne

30
Q

What is high in the blood of someone with late onset/mild adrenal hyperplasia?

A

17-hydroxyprogesterone

31
Q

List some genital tract abnormalities which could lead to amenorrhoea

A

Ashermann’s syndrome

Imperforate hymen/transverse vaginal septum

Mayer-Rokitansky-Küster-hauser syndrome

32
Q

Describe Ashermann’s syndrome

A

Can occur secondary to instrumentation of the uterus typically following surgical management of miscarriage
Damages the basal layer of endometrium which causes intrauterine adhesions which fail to respond to oestrogen stimulus

33
Q

Describe how an imperforate hymen or transverse vaginal septum leads to amenorrhoea

A

Mechanical obstruction

34
Q

Describe mayer-rokitansky-kuster-hauser syndrome

A

Agenesis of the Mullerian duct system in varying degrees

Congenital absence of the uterus and upper 2/3 of the vagina

35
Q

List the common causes of oligomenorrhoea/secondary amenorrhoea

A 
PCOS
Contraceptive/hormonal treatment
Perimenopause
Thyroid disorders
DM
Eating disorders
Excess exercise
Medications - antiepileptics and antipsychotics
36
Q

Describe the stepwise approach to investigating amenorrhoea/oligomenorrhoea

A

History
Examination
Pregnancy test
Blood tests - TFTs, prolactin, FSH/LH/progesterone/testosterone, 17-hydroxyprogesterone
Karyotyping
Ultrasound scan
Progesterone challenge test to ellicit withdrawla bleed

37
Q

What does a withdrawal bleed after progesterone challenge suggest?

A

Adequate levels of oestrogen but lack of ovulation - PCOS

38
Q

What does no withdrawal bleed after progesterone challenge suggest?

A

Low levels of oestrogen or an outflow obstruction

39
Q

Describe the hormonal picture for hypothalamic causes

A 
Decreased GnRH
Normal FSH
Normal/Low LH
Decreased LH:FSH ratio 
Decreased oestrogen
40
Q

Describe the hormonal picture for a prolactinoma

A

Decreased GnRH

Increased prolactin

41
Q

Describe the hormonal picture for PCOS

A

Normal FSH
Increased LH
Increased LH:FSH ratio
Normal/increased testosterone

42
Q

Describe the hormonal picture for premature ovarian failure

A

Increased FSH
Increased LH
Decreased osterogen

43
Q

What does management depend on?

A

The cause

44
Q

What do the general aims of treating amenorrhoea/oligomenorrhoea include?

A 
Regulating periods
Hormone replacement
Symptom control 
Lifestyle advice
Treat underlying disorder 
Improving fertility 
Surgery
45
Q

How can periods be regulated?

A

Contraceptive pill - COP/Progesterone only

IUS - helpful in heavy periods

46
Q

Describe the use of hormone replacement in premature ovarian failure/insufficiency

A

Cyclical HRT with oestrogen (and progesterone if the woman still has a uterus)
Treats the symptoms and decreases risk of cardiovascular disease and maintains bone mineral density to prevent osteoporosis

47
Q

What medications can be used to manage excessive hair growth

A

Yasmin, cyproterone acetate, spironolactone, finasteride

48
Q

Which drug can be given to stimulate ovulation?

A

Clomifene

Obstetrics and gynaecology (67 decks)

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