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Reproductive Health > Infrequent Or Absent Periods > Flashcards

Infrequent Or Absent Periods Flashcards

1
Q

What does oligomenorrhoea mean?

A

Infrequent periods

With intervals between menstrual cycles of more than 35 days but less than 6 months

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2
Q

What is amenorrhoea?

A

Absence of menstrual periods

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3
Q

What is primary amenorrhoea?

A

Failure to commence menses - no menarche by 16

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4
Q

What is secondary amenorrhoea?

A

Absent periods for at least 3/12 if previously regular

Absent periods for at least 6/12 if previously oligomenorrhoea

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5
Q

What needs to be functioning to achieve regular menstrual cycles?

A

All functions of the hypothalamus- pituitary - ovarian axis

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6
Q

What causes oligomenorrhoea?

A

Constitutional - long cycle then period every 2 weeks and no pathology on investigation
Anovulation - PCOS, thyroid disease, prolactinoma, CAH
Contraceptive/ hormonal treatment
Perimenopause
Eating disorders / excessive exercise
Medications - anti psychotics, AEDs

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7
Q

What causes amenorrhoea?

A 
Physiological - prepubertal, pregnancy, menopause 
Crytomenorrhoea 
Uterine/ endometrial causes
Ovarian causes
Pituitary causes 
Hypothalamic causes
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8
Q

Why can disease of the hypothalamus cause amenorrhoea?

A

They can reduce the secretion of GnRH in turn decreasing the pulsatile release of LH and FSH from anterior pituitary, causing anovulation

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9
Q

What can cause hypothalamic amenorrhoea?

A

Functional disorders - eating disorders, exercise - suppress GnRH production
Severe chronic conditions - psychiatric disorders, thyroid disease, sarcoidosis
Kallmann syndrome - an x linked recessive disorder characterised by failure of migration of GnRH cells

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10
Q

What can cause pituitary amenorrhoea?

A

Prolactinomas - tumours that secrete high levels of prolactin, which suppresses GnRH secretion
Other pituitary tumours
Sheehan’s syndrome
Destruction of pituitary gland - radiation or autoimmune disease
Post contraception amenorrhoea - prolonged use can cause down regulation of pituitary gland (most commonly seen with depo provera)

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11
Q

What is Sheehan’s syndrome?

A

Post partum pituitary necrosis secondary to massive obstetric haemorrhage

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12
Q

What can cause ovarian amenorrhoea?

A 
PCOS - more commonly causes oligomenorrhoea, but can present with amenorrhoea 
Turners syndrome (45X0) 
Premature ovarian failure - primary ovarian insufficiency before 40
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13
Q

What is Turner’s syndrome?

A

A genetic condition - female is partially or completely missing an X chromosome.
Symptoms: amenorrhoea, failure to develop secondary sexual characteristics and almost universal infertility.

Many other features - short stature, webbed neck…

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14
Q

How can diseases of adrenal gland cause amenorrhoea?

A

They can affect ovulation
Late onset /mild congenital adrenal hyperplasia
(An autosomal recessive inherited condition, caused by a partial deficiency of 21 hydroxylase - an enzyme required for synthesis of cortisol and aldosterone)
- may present with early development of pubic hair, irregular or absent periods, hirsutism and acne
- high levels of 17- hydroxyprogesterone present in blood

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15
Q

What is crytomenorrhoea?

A

When menstruation occurs but is not visible due to obstruction of outflow tract

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16
Q

What examples of crytomenorrhoea are there?

A

Imperforate hymen
Transverse vaginal septum
Absent vagina

17
Q

What PRIMARY amenorrhoea causes are there?

A 
Delayed puberty
Imperforate hymen/ transverse septum
Absent vagina
Mullerian agenesis - no uterus 
Gonadal dysgenesis - Turners syndrome 
PCOS (but less common primary) 
CAH
18
Q

What SECONDARY causes of amenorrhoea are there?

A 
Pregnancy - could be primary 
PCOS
Premature menopause 
Prolactinoma 
Thyroid disease
Cushing’s 
Eating disorder
Exercise induced
Severe stress e.g war zone, famine 
Ashermann’s syndrome - interuterine adhesions 
Sheehan syndrome
19
Q

How does Cushing’s syndrome cause amenorrhoea?

A

High levels of adrenal hormones e.g cortisol and androgens suppress the normal GnRH production, and therefore LH and FSH

20
Q

If the disorder is of higher order centres e.g hypothalamus or pituitary, how will FSH and ovarian hormones be affected?

A

FSH low

No significant ovarian stimulation, so low levels of oestrogen and progesterone secretion

21
Q

If there is ovarian dysfunction, what will the levels of FSH, oestrogen and progesterone be?

A

FSH high
Oestrogen low
Virtually no progesterone

22
Q

What baseline investigations should be done?

A 
Pregnancy test
TFT
Prolactin 
FSH, LH
17 hydroxyprogesterone (CAH) 
USS to visualise ovaries and pelvic anatomy
23
Q

When investigating primary amenorrhoea, if FSH is low what does this suggest?

A 
Constitutional delay
Eating disorder
Exercise induced
Stress (severe)
Chronic illness
24
Q

When investigating primary amenorrhoea, if FSH is high what should be done?

A

A karyotype

46XX : premature ovarian failure
45XO : Turners syndrome

25
Q

If there is a problem with the uterus, will all the blood test be normal?

A

Yes - feedback mechanism not interrupted

26
Q

Why is USS done?

A

See if uterus is present or absent

Also look at ovaries - PCOS

27
Q

If primary amenorrhea and USS shows uterus present with normal FSH. What may be the cause?

A

Obstructive problem e.g imperforate hymen, vaginal agenesis, transverse septum

28
Q

If primary amenorrhoea and USS shows absent uterus, what should be done?

A

A karyotype

46XX - mullerian agenesis
46XY - androgen insensitivity

29
Q

What should be done when investigating secondary amenorrhoea?

A

History and examination
Baseline tests (same as primary amenorrhoea)
- TFT, prolactin, LH, FSH, pregnancy test

30
Q

In secondary amenorrhoea, if FSH low, what could this indicate?

A 
Same as primary e.g 
Eating disorder
Exercise induced 
Severe stress
Chronic illness

Also - Sheehan syndrome (occurs after massive PPH)

31
Q

In secondary amenorrhoea, what could be the cause if FSH is high?

A

Premature ovarian failure

Turners mosaic

32
Q

In secondary amenorrhoea, what should be done if FSH is normal?

A

Pelvic USS
PCOS
Uterine adhesions

Reproductive Health (70 decks)

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