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3. Y5 Zero to finals: O&G > Amenorrhoea + Oligomenorrhoea > Flashcards

Amenorrhoea + Oligomenorrhoea Flashcards

1
Q

How do you classify Amenorrhoea?

A

Primary and Secondary

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2
Q

What is Primary Amenorrhoea? (2 things)

A

Failure to start menses (aka no menarche) in:

  1. 16+ yr w secondary sexual characteristics (e.g pubic hair / breast dev)
  2. 14+ yr w NO secondary sexual characteristics
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3
Q

What is Secondary Amenorrhoea?

A

Periods stop for 6+ months (after menarche obv)

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4
Q

What is Oligomenorrhoea? (2 things)

A
  1. Irregular periods w intervals of 35+ days
  2. +/- Less than 9 periods / year
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5
Q

What are the titles of the causes of Amenorrhoea? (3 things)

A
  1. Hypothalamic causes
  2. Pituitary causes
  3. Ovarian / Genital causes
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6
Q

How does clartation of the Hypothalamus cause Amenorrhoea? (3 steps)

A
  1. Reduced GnRH secretion
  2. Reduces pulsatile release of LH + FSH from Ant Pit
  3. Anovulation
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7
Q

What are the Hypothalamic causes of Amenorrhoea? (3 things)

A
  1. Anorexia nervosa
  2. Extreme exercise
  3. Stress
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8
Q

How does clartation of the Pituitary gland cause Amenorrhoea? (2 steps)

A
  1. Reduced release of LH + FSH from Ant Pit
  2. Anovulation
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9
Q

What are the Pituitary causes of Amenorrhoea? (3 things)

A
  1. Prolactinoma
  2. Pituitary adenoma
  3. Sheehan’s syndrome
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10
Q

How do Prolactinomas cause Amenorrhoea? (4 steps)

A
  1. High levels of prolactin released
  2. Prolactin inhibits GnRH sec
  3. Reduces pulsatile release of LH + FSH from Ant Pit
  4. Anovulation
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11
Q

What is Sheehan’s syndrome?

A

Post-partum pituitary necrosis (secondary to massive obstetric haemorrhage)

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12
Q

What are the Ovarian / Genital causes of Amenorrhoea? (3 things)

A
  1. PCOS
  2. Ovarian failure
  3. Ashermann’s syndrome
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13
Q

Does PCOS more commonly cause Amenorrhoea or Oligomenorrhoea?

A

Oligomenorrhoea

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14
Q

What is Ovarian failure?

A

Premature ovarian insuffiency (aka menopause before age of 40)

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15
Q

What are the CF of Ovarian failure?

A

Menopause symptoms like hot / night sweats

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16
Q

What do hormone profile tests show in Ovarian failure? (2 things)

A
  1. Low oestrogen
  2. High FSH
17
Q

What is Ashermann’s syndrome?

A

Damage to basal layer of endometrium –> intrauterine adhesions

18
Q

What causes Ashermann’s syndrome?

A

Damage to uterus from Surgical management of miscarriage

19
Q

What are the most common causes of Oligomenorrhoea? (7 things)

A
  1. PCOS
  2. Contraceptive / hormonal tx
  3. Perimenopause
  4. Hypo / Hyperthyroidism
  5. DM
  6. Eating disorders / excessive exercise
  7. Medications
20
Q

How can Hypothyroidism cause Oligomenorrhoea? (4 steps)

A
  1. Decreased T3/T4
  2. TRH upregulated
  3. Stimulates Prolactin secretion
  4. LH / FSH inhibited
21
Q

How can Hyperthyroidism cause Oligomenorrhoea? (4 steps)

A
  1. High T3/T4
  2. Increased Sex Hormone Binding Globulin (SHBG)
  3. Reduced ratio of free / bound oesteadiol
  4. LH spike not triggered
22
Q

What medications can cause Oligomenorrhoea? (2 things)

A
  1. Anti-psychotics
  2. Anti-epileptics
23
Q

What investigations should you do for Amenorrhoea / Oligomenorrhoea? (5 things)

A
  1. Pregnancy test
  2. Bloods
  3. Karyotyping
  4. US
  5. Progesterone challenge test
24
Q

What bloods should you do for Amenorrhoea / Oligomenorrhoea? (4 things)

A
  1. TFT
  2. Prolactin
  3. FSH / LH / Oestradiol / Progesterone / Testosterone
  4. 17 hydroxyprogesterone (to check for Congenital adrenal hyperplasia)
25
Q

Why would you do Karyotyping for Amenorrhoea / Oligomenorrhoea?

A

If sus genetic abn

26
Q

Why would you do US for Amenorrhoea / Oligomenorrhoea?

A

To visualise ovaries / pelvic anatomy

27
Q

What is the Progesterone challenge test?

A

Giving progesterone to see if bleeding will start

28
Q

What does the Progesterone challenge test show? (2 things)

A
  1. If bleeding starts: suggests adeq levels of oestrogen but NO ovulation = PCOS
  2. If no bleeding: suggests LOW levels of oestrogen / outflow obstruction
29
Q

What are the titles of Tx for Amenorrhoea / Oligomenorrhoea? (7 things)

A
  1. Regulating periods
  2. Hormone replacement
  3. Symptom control
  4. Lifestyle advice
  5. Tx underlying disorder (aka thyroid disease)
  6. Improving fertility (clomifene / metformin / IVF)
  7. Surgery
30
Q

How do you Regulate periods to treat Amenorrhoea / Oligomenorrhoea? (2 things)

A
  1. COCP / POP
  2. Intrauterine system (IUS) (for irregular periods)
31
Q

What is another benefit of using COCP / POP to treat Amenorrhoea / Oligomenorrhoea?

A

Keeps lining of womb thin –> reduces long term risk endometrial cancer

32
Q

Who should receive Hormone replacement as Tx for Amenorrhoea / Oligomenorrhoea?

A

Women w Ovarian Failure

33
Q

What is Hormone replacement tx for Amenorrhoea / Oligomenorrhoea?

A

Cyclic hormone replacement therapy w Oestrogen (+ progesterone if they have a uterus)

34
Q

What are the benefits of Hormone replacement as treatment in Amenorrhoea / Oligomenorrhoea? (3 things)

A
  1. Treats menopause symptoms
  2. Decreases CVS risk
  3. Maintains bone density (prevents osteoporosis)
35
Q

What is also recommended alongside Hormone replacement tx for Amenorrhoea / Oligomenorrhoea?

A

Calcium + Vit D supplementation

36
Q

What types of Symptom control are available for Amenorrhoea / Oligomenorrhoea? (2 things)

A
  1. Excessive hair growth (from PCOS): Certain COCP types e.g Yasmin
  2. Acne: Abx / topical tx
37
Q

What Lifestyle advice options could you give for Amenorrhoea / Oligomenorrhoea? (2 things)

A
  1. Eating disorders / excessive exercise: sort it out m8
  2. PCOS: weight loss
38
Q

What are the Surgical Mx options for Amenorrhoea / Oligomenorrhoea? (2 things)

A
  1. Trans-sphenoidal removal of Pit tumour
  2. Surgery for genital tract abn

3. Y5 Zero to finals: O&G (27 decks)

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