Amenorrhoea & Ovarian enlargement Flashcards
Primary vs Secondary
Amenorrhoea may be divided into:
primary: defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development), or by 13 years of age in girls with no secondary sexual characteristics
secondary: cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea
Primary amenorrhoea:
gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
testicular feminisation
congenital malformations of the genital tract
functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
congenital adrenal hyperplasia
imperforate hymen
Secondary amenorrhoea (after excluding pregnancy):
hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
polycystic ovarian syndrome (PCOS)
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis*
Sheehan’s syndrome
Asherman’s syndrome (intrauterine adhesions)
Ovarian enlargement: management
The initial imaging modality for suspected ovarian cysts/tumours is ultrasound. The report will usually report that the cyst is either:
simple: unilocular, more likely to be physiological or benign
complex: multilocular, more likely to be malignant
Management depends on the age of the patient and whether the patient is symptomatic. It should be remembered that the diagnosis of ovarian cancer is often delayed due to a vague presentation.
Premenopausal women:
Conservative approach may be taken for
-younger women (especially if *< 35 years) as malignancy is less common. If the cyst is small (e.g. *< 5 cm) and reported as *‘simple’ then it is highly likely to be *benign. A *repeat ultrasound should be arranged for *8-12 weeks and referral considered if it persists.
Postmenopausal women:
by definition physiological cysts are *unlikely
any postmenopausal woman with an ovarian cyst *regardless of nature or size should be *referred to gynaecology for assessment
