Amenorrhoea + Oligomenorrhoea Flashcards
How do you classify Amenorrhoea?
Primary and Secondary
What is Primary Amenorrhoea? (2 things)
Failure to start menses (aka no menarche) in:
- 16+ yr w secondary sexual characteristics (e.g pubic hair / breast dev)
- 14+ yr w NO secondary sexual characteristics
What is Secondary Amenorrhoea?
Periods stop for 6+ months (after menarche obv)
What is Oligomenorrhoea? (2 things)
- Irregular periods w intervals of 35+ days
- +/- Less than 9 periods / year
What are the titles of the causes of Amenorrhoea? (3 things)
- Hypothalamic causes
- Pituitary causes
- Ovarian / Genital causes
How does clartation of the Hypothalamus cause Amenorrhoea? (3 steps)
- Reduced GnRH secretion
- Reduces pulsatile release of LH + FSH from Ant Pit
- Anovulation
What are the Hypothalamic causes of Amenorrhoea? (3 things)
- Anorexia nervosa
- Extreme exercise
- Stress
How does clartation of the Pituitary gland cause Amenorrhoea? (2 steps)
- Reduced release of LH + FSH from Ant Pit
- Anovulation
What are the Pituitary causes of Amenorrhoea? (3 things)
- Prolactinoma
- Pituitary adenoma
- Sheehan’s syndrome
How do Prolactinomas cause Amenorrhoea? (4 steps)
- High levels of prolactin released
- Prolactin inhibits GnRH sec
- Reduces pulsatile release of LH + FSH from Ant Pit
- Anovulation
What is Sheehan’s syndrome?
Post-partum pituitary necrosis (secondary to massive obstetric haemorrhage)
What are the Ovarian / Genital causes of Amenorrhoea? (3 things)
- PCOS
- Ovarian failure
- Ashermann’s syndrome
Does PCOS more commonly cause Amenorrhoea or Oligomenorrhoea?
Oligomenorrhoea
What is Ovarian failure?
Premature ovarian insuffiency (aka menopause before age of 40)
What are the CF of Ovarian failure?
Menopause symptoms like hot / night sweats
What do hormone profile tests show in Ovarian failure? (2 things)
- Low oestrogen
- High FSH
What is Ashermann’s syndrome?
Damage to basal layer of endometrium –> intrauterine adhesions
What causes Ashermann’s syndrome?
Damage to uterus from Surgical management of miscarriage
What are the most common causes of Oligomenorrhoea? (7 things)
- PCOS
- Contraceptive / hormonal tx
- Perimenopause
- Hypo / Hyperthyroidism
- DM
- Eating disorders / excessive exercise
- Medications
How can Hypothyroidism cause Oligomenorrhoea? (4 steps)
- Decreased T3/T4
- TRH upregulated
- Stimulates Prolactin secretion
- LH / FSH inhibited
How can Hyperthyroidism cause Oligomenorrhoea? (4 steps)
- High T3/T4
- Increased Sex Hormone Binding Globulin (SHBG)
- Reduced ratio of free / bound oesteadiol
- LH spike not triggered
What medications can cause Oligomenorrhoea? (2 things)
- Anti-psychotics
- Anti-epileptics
What investigations should you do for Amenorrhoea / Oligomenorrhoea? (5 things)
- Pregnancy test
- Bloods
- Karyotyping
- US
- Progesterone challenge test
What bloods should you do for Amenorrhoea / Oligomenorrhoea? (4 things)
- TFT
- Prolactin
- FSH / LH / Oestradiol / Progesterone / Testosterone
- 17 hydroxyprogesterone (to check for Congenital adrenal hyperplasia)
Why would you do Karyotyping for Amenorrhoea / Oligomenorrhoea?
If sus genetic abn
Why would you do US for Amenorrhoea / Oligomenorrhoea?
To visualise ovaries / pelvic anatomy
What is the Progesterone challenge test?
Giving progesterone to see if bleeding will start
What does the Progesterone challenge test show? (2 things)
- If bleeding starts: suggests adeq levels of oestrogen but NO ovulation = PCOS
- If no bleeding: suggests LOW levels of oestrogen / outflow obstruction
What are the titles of Tx for Amenorrhoea / Oligomenorrhoea? (7 things)
- Regulating periods
- Hormone replacement
- Symptom control
- Lifestyle advice
- Tx underlying disorder (aka thyroid disease)
- Improving fertility (clomifene / metformin / IVF)
- Surgery
How do you Regulate periods to treat Amenorrhoea / Oligomenorrhoea? (2 things)
- COCP / POP
- Intrauterine system (IUS) (for irregular periods)
What is another benefit of using COCP / POP to treat Amenorrhoea / Oligomenorrhoea?
Keeps lining of womb thin –> reduces long term risk endometrial cancer
Who should receive Hormone replacement as Tx for Amenorrhoea / Oligomenorrhoea?
Women w Ovarian Failure
What is Hormone replacement tx for Amenorrhoea / Oligomenorrhoea?
Cyclic hormone replacement therapy w Oestrogen (+ progesterone if they have a uterus)
What are the benefits of Hormone replacement as treatment in Amenorrhoea / Oligomenorrhoea? (3 things)
- Treats menopause symptoms
- Decreases CVS risk
- Maintains bone density (prevents osteoporosis)
What is also recommended alongside Hormone replacement tx for Amenorrhoea / Oligomenorrhoea?
Calcium + Vit D supplementation
What types of Symptom control are available for Amenorrhoea / Oligomenorrhoea? (2 things)
- Excessive hair growth (from PCOS): Certain COCP types e.g Yasmin
- Acne: Abx / topical tx
What Lifestyle advice options could you give for Amenorrhoea / Oligomenorrhoea? (2 things)
- Eating disorders / excessive exercise: sort it out m8
- PCOS: weight loss
What are the Surgical Mx options for Amenorrhoea / Oligomenorrhoea? (2 things)
- Trans-sphenoidal removal of Pit tumour
- Surgery for genital tract abn
