GYN: General Gynaecology -- Amenorrhoea

Question 1

Clinical signs to look for in hyperprolactinemia

Answer 1

• Galactorrhoea
• Bilateral hemianopia
• Signs of hypoT

Question 2

Further investigations for hyperprolactinemia

Answer 2

• Pregnancy test
• Blood:
  
  • PRL
  • TFT
• MRI pituitary

Question 3

Management for hyperprolactinaemia

Answer 3

• Bromocriptine
• refer to neurosurgery if pituitary macroadenoma (>10mm) is detected

Question 4

How to manage a patient with hyperprolactinaemia, having bromocriptine, during pregnancy?

Answer 4

• Stop bromocriptine
• Regular FU Q3m
• Restart if symptomatic

Question 5

What is one simple test for secondary amenorrhoea patient to do before entering the clinic?

Answer 5

Urine pregnancy test

Question 6

Causes of secondary amenorrhoea

Answer 6

1. Ovary
   
   • PCOS, Turner’s syndrome…
2. Pituitary
   
   • Tumour, Surgery, Radiation, Sheehan’s syndrome…
3. Hypothalamus
   
   • Kallman’s syndrome, HyperPRL, Primary hypoT, AN, stress…
4. Uterine
   
   • Imperforate hymen, transverse vaginal septum…

Question 7

Common symptoms of menopause

Answer 7

hot flush, night sweat, palpitations, labile mood, irritability, sleep disturbance…

Question 8

Treatment to prevent menopause symptoms in premature menopause patients

Answer 8

• Hormonal replacement therapy (Cyclical regimen) until the average age of natural menopause
• Lifestyle:
  
  • smoking cessation
  • avoid strong tea, coffee
  • adequate calcium, vit D intake
  • regular exercise

Question 9

Appropriate genetic test to investigate the cause of premature menopause

Answer 9

• Karyotyping for Turner’s syndrome
• Fragile X PCR

Question 10

How can a premature menopause patient be pregnant?

Answer 10

Oocyte donation

Question 11

Conditions associated with PCOS

Answer 11

• Infertility
• DM, HT
• Endometrial CA

Question 12

Investigations for PCOS

Answer 12

• Female androgen profile
• Early follicular FSH, LH, E2 to confirm normogonadotropic amenorrhoea
• Medatoblic profile (fasting lipid, glucose, LFT)
• PRL, TFT, Pregnancy test to rule out other causes of amenorrhoea

Question 13

Investigations for infertility

Answer 13

1. Semen analysis
2. Ovulation assessment: BBT chart, mid-luteal phase progesterone, serial testing for LH surge, serial USG monitoring for follicular growth
   
   • if anovulatory: early follicular FSH LH E2, TFT, PRL, female androgen profile
3. Hysterosalpingogram (HSG), Lap dye
4. 2D/3D pelvic USG, Hysteroscopy

Question 14

Investigations for ovarian hyperstimulation syndrome

Answer 14

• CBC: hematocrit, WCC (for haemoconcentration)
• LRFT
• Clotting profile (for thromboembolism)
• CXR (for pleural effusion)
• Pelvic USG (for ascites, ovarian size)

Question 15

MC cause for secondary amenorrhoea

Answer 15

pregnancy