Gynae: Amenorrhoea

Question 1

Differential diagnosis of secondary amenorrhoea

Answer 1

Hypothalamic:

• Chronic Illness
• Anorexia
• Excessive excercise
• Stress

Pituitary:

• Hyperprolactinaemia (Eg drugs, tumour)
• Hypothyroidism
• Breast-feeding

Ovarian (ie anovulatory causes):

• Polycystic ovarian syndrome
• Premature ovarian failure
• Iatrogenic (Chemo, radio, oophorectomy)
• Long-acting progesterone contraception)

Uterine:

• Pregnancy
• Asherman’s syndrome (Scarring due to surgery)
• Cervical stenosis

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Question 2

Secondary amenorrhoea, day 21 progesterone is low. What are the possible causes?

Answer 2

Hypothalamic:

• Chronic Illness
• Anorexia
• Excessive excercise
• Stress

Pituitary:

• Hyperprolactinaemia (Eg drugs, tumour)
• Hypothyroidism
• Breast-feeding

Ovarian:

• Polycystic ovarian syndrome
• Premature ovarian failure
• Iatrogenic (Chemo, radio, oophorectomy)

Uterine:

• Asherman’s syndrome (Scarring due to surgery)
• Cervical stenosis

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Question 3

What are the hypothalamic causes of secondary amenorrhoea?

Answer 3

Hypothalamic:

• Chronic Illness
• Anorexia
• Excessive excercise
• Stress

Question 4

What are the pituitary causes of secondary amenorrhoea?

Answer 4

Pituitary:

• Hyperprolactinaemia (Eg drugs, tumour)
• Hypothyroidism
• Breast-feeding

Question 5

What are the ovarian causes of secondary amenorrhoea?

Answer 5

Ovarian (ie anovulatory causes):

• Polycystic ovarian syndrome
• Premature ovarian failure
• Iatrogenic (Chemo, radio, oophorectomy)
• Long-acting progesterone contraception)

Question 6

What are the uterine causes of secondary amenorrhoea?

Answer 6

Uterine:

• Pregnancy
• Asherman’s syndrome (Scarring due to surgery)
• Cervical stenosis