Common gynae histories - secondary amenorrhoea

Question 1

What would you ask about secondary amenorrhoea?

Answer 1

• Duration
• Triggers

Question 2

What would you ask about in terms of trying to figure out a cause of secondary amenorrhoea?

Answer 2

• General - weight loss, stress, exercise, diet
• Head - visual problems, headaches
• Thyroid symptoms
• Torso - galactorrhoea, hirsuitism, acne
• Abdomen - possibility of pregnancy

Question 3

What gynaecological symptoms would you ask about on systemic enquiry?

Answer 3

• PV discharge
• Pain
• Pregnancy

Question 4

What aspects of a gynae history would you want to make sure to ask about when exploring symptoms of secondary amenorrhoea?

Answer 4

• Sexual history
• Contraception

Question 5

What features of secondary amenorrhoea which would suggest pregnancy?

Answer 5

• Trying to get pregnant
• Unprotected sex

Question 6

What features assocaited with secondary amenorrhoea suggest PCOS?

Answer 6

• Acne
• Hirstuitism
• Obesity
• Diabetes

Question 7

What features assocaited with secondary amenorrhoea would suggest menopause/premature ovarian failure?

Answer 7

Menopausal symptoms

• Sweats/flushes
• Aches and pains
• Previous erratic menstrual cycles
• Emotional changes

Question 8

What feature assocaited with secondary amenorrhoea suggest hypothalamic amenorrheoa (e.g. anorexia, stress, athletes)?

Answer 8

• Extreme anxiety, stress or exertion
• Poor diet
• Excessive weight loss
• Low BMI

Question 9

What features of secondary amenorrhoea suggest cushing’s syndrome?

Answer 9

• Steroid use
• Thin skin/bruising
• Central obesity
• Fat redistribution

Question 10

What features associated with secondary amenorrhoea would suggest hyperprolactinaemia?

Answer 10

• Use of anti-psychotics
• Visual symtpoms - tumour
• Galactorrhoea
• Infertility

Question 11

What are gynaecological causes of seconadry amenorrhoea?

Answer 11

• Pregnancy
• PCOS
• Menopause
• Post-pill/contraception
• Cervical stenosis

Question 12

What are endocrine causes of secondary amenorrhoea?

Answer 12

• Hypothalamic amenorrhoea
• Cushing’s syndrome
• Hyperprolactinaemia
• Hyper/hypothyroidism

Question 13

What are non-gyne or endocrine causes of secondary amenorrhoea?

Answer 13

• Severe systemic illness
• Drugs - hormonal treatments, contraception, chemotherapy, antipsychotics