Amenorrhoea history

Question 1

Primary amenorrhoea history

Answer 1

Non-pathological

• Constitutional delay
  
  • Delayed development of secondary sexual characteristics
  • FHx of delayed puberty?
• Drugs (increase prolactin)
  
  • Antidepressants
  • Antihypertensives

Pathological

• Hypothalamic hyogonadism (↓ GnRH)
  
  • Emotional stress
  • Excessive exercise
  • Low weight/Anorexia
  • Kallman’s syndrome (Anosmia)
    
    • Gonadotrophin deficiency (LH and FSH)
• Hyperprolactinaemia (Galactorrhoea?)
  
  • Tumour (headache, visual disturbances?)
  • Hypothyroidism
    
    • Lethargy
    • Dry skin/hair
    • Cold intolerance
    • Constipation
    • Weight gain
  • Drugs (above)
• Outflow tract obstruction (imperforate hymen)
  
  • Pubertal development with cyclic pelvic pain
• Turner’s
  
  • Short stature? (compare height with other family members)
  • Webbed neck
• Mullerian agenesis
  
  • Inability to have vaginal intercourse

Question 2

Secondary amenorrhoea history

Answer 2

*PREGNANCY UNTIL PROVEN OTHERWISE*

• How long have periods been absent?
• Were periods regular before now?
• Menstrual Hx

Differentials

• Physiological
  
  • Pregnancy
  • Lactation
  • Postmenopause
  • Hormone contraceptives
• Premature ovarian failure (menopause)
  
  • Age < 40
  • Vasomotor symptoms (hot flushes, palpitations)
  • Vaginal dryness
  • Decreased libido
  • Weight gain
• Polycystic ovary syndrome
  
  • Hirsutism
  • Acne
  • Weight gain
• Hyperprolactinaemia (Galactorrhoea?)
  
  • Tumour (headache, visual disturbances?)
  • Hypothyroidism
    
    • Lethargy
    • Dry skin/hair
    • Cold intolerance
    • Constipation
    • Weight gain
  • Drugs
    
    • Antidepressants
    • Antihypertensives
• Behavioural
  
  • Emotional stress
  • Excessive exercise
  • Low weight/Anorexia
• Surgery
  
  • Hysterectomy
  • Oophorectomy
  • Cervical stenosis