Menorrhagia & Amenorrhoea

Question 1

What is Amenorrhoea?

Answer 1

Primary amenorrhoea: Menstruation has not started by the age of 16.

Secondary amenorrhoea: The absence of menstruation for 6/12 in a woman who previously had normal menstruation.

Question 2

What are the causes of PRIMARY amenorrhoea?

Answer 2

The causes of PRIMARY amenorrhoea include:
Turner syndrome.
Androgen insensitivity syndrome (AIS).
Congenital malformations
Congenital adrenal hyperplasia

Question 3

What are the causes of SECONDARY amenorrhoea?

Answer 3

The causes of SECONDARY amenorrhoea include:
Pregnancy (#1 cause).
Polycystic very syndrome.
Premature ovarian failure.
Pituitary necrosis after PPH
Hyperprolactinaemia
Hypothalamic disorders (anorexia, stress, excessive exercise).
Hyper/hypothyroidism

Question 4

What are the investigations of amenorrhoea?

Answer 4

The investigations of amenorrhoea MAY include:
ß-hGC levels
FBC
U&E
TFTs
Gonadotropin levels
Prolactin levels
Androgen levels
Oestradiol levels
Radiology if tutor suspected

Question 5

What is menorrhagia?

Answer 5

Menorrhagia is heavy mensural bleeding defined by what the woman feels to be excessive (previously defined as >80mL)

Question 6

What are the causes of menorrhagia?

Answer 6

The causes of menorrhagia include:
Polyps (uterine)
Fibroids
Bleeding disorders
Endometriosis
Endometrial carcinoma
Endometrial hyperplasia
PID
IUD
Idiopathic

Question 7

What are the treatment options for menorrhagia?

Answer 7

Treatment options for menorrhagia MAY include:

Medical
1st line: Mirena intrauterine system
2nd line: Mefenamic acid, TXA, combined oral contraceptive pill
3rd line: long acting progensogens

Surgical
Endometrial ablation
Hysterectomy

Question 8

What are the investigations into menorrhagia?

Answer 8

The investigations into menorrhagia MIGHT include:
FBC (in all cases) to rule out anaemia
U&Es
TFTs
USS
Hysteroscopy
Endometrial biopsy

(also see local guidelines)