gonads Flashcards
amenorrhoea: Define amenorrhoea, list the causes, investigations and management
define amenorrhoea
absence of periods
define primary amenorrhoea
failure to begin spontaneous menstruation by age 16 years
define secondary amenorrhoea
absence of menstruation for 3 months in a woman who has previously had cycles
define oligomenorrhoea and what can it be associated with
irregular long cycles (not between 25-35 days); associated with PCOS
6 causes of amenorrhoea
pregnancy, lactation, ovarian failure, gonadotrophin failure, hyperprolactinaemia, androgen excess
3 causes of ovarian failure in amenorrhoea
premature ovarian insufficiency (POI) causing infertility, ovariectomy/chemotherapy, ovarian dysgenesis (Turners 45 XO - lacking one chromosome)
3 features of Turners syndrome (45 XO)
short stature, cubitus valgus, gonadal dysgenesis
4 causes of gonadotrophin failure in amenorrhoea
hypothalamus/pituitary disease, Kallmann’s syndrome (anosmia, low GnRH), low BMI (leptin), post pill amenorrhoea (so stop pill every 4 years as hypothalamus is temporarily not working)
cause of androgen excess in amenorrhoea
gonadal tumour
7 investigations of amenorrhoea
pregnancy test; check LH, FSH and oestradiol levels; day 18, 21 and 24 progesterone levels (if ovulated, progesterone peaks at day 21 on 28 day cycle); prolactin, thyroid function tests; androgens (relevant to PCOS: testosterone, androstenedione, DHEAS); chromosomal analysis (Turners 45 XO); ultrasound scan ovaries/uterus (indicate PCOS)
treatment for amenorrhoea: cause
treat cause (e.g. low weight)
treatment for amenorrhoea: primary ovarian insufficiency causing infertility
hormone replacement therapy
2 treatments for amenorrhoea (if want to be fertile, or wish to remain infertile): hypothalamic/pituitary disease
hormone replacement therapy for oestrogen replacement if not interested in fertility, gonadotrophins (LH and FSH) as part of IVF treatment for infertility
