Amenorrhoea/Oligomenorrhoea

Question 1

Sequence of events

Answer 1

Open question
LMP
Cycle (what was it like before) 
Menarche
Smear history

Question 2

Systems review

Answer 2

Pregnancy- possibility?
Contraception- do you use? which one, how long, what were your periods like before
PCOS- acne, hair growing in unusual places, weight
Thyroid dysfunction- appetite, tremor, bowels, temperature
Hypogonadotropic hypogonadism- do you often exercise, low in mood or anxious recently
perimenopause/menopause- sweating or hot flush, more tired or irritable, libido, painful sex
Hyperprolactinaemia- discharge from nipples, problems with vision
Obstetric- any children, problems trying to conceive, if so, do you know why

Question 3

Systems review

Answer 3

Pregnancy- possibility?
Contraception- do you use? which one, how long, what were your periods like before
PCOS- acne, hair growing in unusual places, weight
Thyroid dysfunction- appetite, tremor, bowels, temperature
Hypogonadotropic hypogonadism- do you often exercise, low in mood or anxious recently
perimenopause/menopause- sweating or hot flush, more tired or irritable, libido, painful sex
Hyperprolactinaemia- discharge from nipples, problems with vision
Obstetric- any children, problems trying to conceive, if so, do you know why

Question 4

patients perspective

Answer 4

Feelings and effect on life

ICE

Question 5

Background

Answer 5

PMH- thyroid, PCOS, eating disorder
DH
FH- any autoimmune thyroid disease, how old was your mum when she had her menopause
SH

Question 6

Primary amenorrhoea

Answer 6

Not reached menarche by 16

Most commonly constitutional delay (family history eg. mother, sister etc.), less commonly Turners, or PCOS

Question 7

Pregnancy

Answer 7

Always check if there is a chance they could be pregnant

Question 8

Drug induced

Answer 8

Progesterone only contraception can cause periods to stop

Reverses within a year of stopping medication

Question 9

PCOS

Answer 9

Symptoms due to excessive androgens
Oligomenorrhoea but also can be amenorrhea
Insulin resistance- obesity and diabetes associated

Question 10

Hyperthyroidisim

Answer 10

typical sx

Question 11

Hypothyroidism

Answer 11

typical sx (usually causes menorrhagia, but can cause oligomenorrhoea)

Question 12

Hypogonadotropic hypogonadism

Answer 12

Low FSH and LH

Most common causes- starvation, excessive exercise, anorexia nervosa, depression, stress, chronic illness, marijuana use

Question 13

Menopause

Answer 13

Peri-menopause- symptoms are felt (the change)
Menopause- when no period for 12 connective months
Premature- before 40

NB- middle-woman presents with reduced/light periods, consider menopause and ask about other vasomotor symptoms

Question 14

Hyperprolactinaemia

Answer 14

Galactorrhoea, amenorrhoea, oligomenorrhoea, subfertility
Bitemporal hemianopia if macroprolactinoma
Other causes- pregnancy, breastfeeding, stress, drugs, pituitary stalk damage

Question 15

Investigations

Answer 15

Bedside- abdominal and PV exam, urinary pregnancy test
Bloods- FBC UE FSH LH oestrogen testosterone TFT’s prolactin
Imaging- TV USS (PCOS), MRI head (prolactinomas)

NB- always consider the patients desire for pregnancy