Gynaecology Flashcards
Define primary amenorrhoea
(2 definitions)
Not starting menstruation
a) by the age of 14, with no other evidence of sexual development
b) by the age of 16, with other signs of sexual development (e.g. breast bud development)
What age ranges does ‘normal’ puberty take place in
a) girls
b) boys
8-14 years
9-15 years
How does puberty normally progress in girls? Which changes occur and in which order?
(3)
Breast bud development (thelarche)
Pubic hair development (pubarche)
Periods starting (menarche)
How long does puberty normally take from start to finish?
4 years
How often does menarche typically occur after onset of puberty?
2 years from start of puberty
What is hypogonadotropic hypogonadism (secondary hypogonadism)?
Gonadal failure (underactive gonads) caused by lack of LH/FSH release from anterior pituitary
Where in the HPG axis is the problem in hypogonadotropic hypogonadism (secondary hypogonadism)?
What will you see on a hormonal profile (LH and FSH levels)?
In the hypothalamus or pituitary gland
Low LH and FSH levels
What is hypergonadotropic hypogonadism (primary hypogonadism)?
Gonadal failure (underactive gonads) due to impaired response of the gonads to FSH and LH stimulation
Where in the HPG axis is the problem in hypergonadotropic hypogonadism (primary hypogonadism)?
What will you see on a hormonal profile (FSH and LH levels)? Why?
In the ovaries (gonads)
High FSH and LH levels
No negative feedback from sex hormone production
Name some endocrine causes of primary amenorrhoea (excluding primary/secondary hypogonadism)
Hypothyroidism Hyperprolactinaemia Congenital adrenal hyperplasia Turners Syndrome Androgen insensitivity Syndrome
What investigations should be ordered for suspected primary amenorrhoea? (2)
Pelvic USS
Hormone tests - FSH, LH, TSH, Prolactin
What are some hypothalamic causes of primary amenorrhoea? (3)
Excessive exercise
Stress
Eating disorder
What is the management of primary amenorrhoea?
Treat underlying cause
Primary ovarian failure or PCOS —> COCP
What is a patient with primary amenorrhoea at risk of, due to low oestrogen levels?
What is the treatment for this, if the primary amenorrhoea has a permanent cause? (2)
Osteoporosis
Ensure adequate vitamin D and calcium
Hormone replacement therapy - e.g. COCP
Define secondary amenorrhoea
No menstruation for more than 3 (or 6) months after having previously started periods
What are the two most common causes of secondary amenorrhoea?
Pregnancy (most common)
Menopause
What are some hypothalamic causes of secondary amenorrhoea?
Excessive exercise
Low BMI
Eating disorder
Stress
State two pituitary causes of secondary amenorrhoea
Prolactinoma (pituitary tumour)
Pituitary failure (Sheehan syndrome)
What are some ovarian causes of secondary amenorrhoea? (3)
PCOS
Premature ovarian failure
Menopause
State a uterine cause of secondary amenorrhoea
Asherman’s Syndrome
What thyroid disorder is associated with secondary amenorrhoea?
Hypothyroidism
Why do high prolactin (hyperprolactinaemia) levels cause secondary amenorrhoea?
Prolactin prevents the release of GnRH from the hypothalamus
Increased prolactin —> Low GnRH —> Low FSH/LH —> hypogonadotropic hypogonadism (primary hypogonadism)
What is the most common cause of hyperprolactinaemia?
Pituitary adenoma secreting prolactin
If high prolactin levels are found on investigation of hyperprolactinaemia, what investigation is indicated?
CT/MRI head