Menstrual Cycle Abnormalities Flashcards
List two examples of physiological amenorrhoea
childhood
pregnancy
post-menopausal
breast feeding
List three investigations for amenorrhoea
FSH/LH
Androgens
USS (PCOS)
What might you see on USS in patient with PCOS?
string of pearls
Name two complications of PCOS
subfertility
acne
hirsutism
List two investigations for menorrhagia
TFTs
FBC
USS (fibroid)
Which fibroid is associated with the most amount of bleeding?
submucosal (Dependent on location of fibroid rather than size and number)
Patient with post-menopausal bleeding. What are you worried about?
endometrial cancer- 10% risk
cervical cancer (lower risk)
List two investigations for post menopausal bleeding
USS
speculum
Post menopausal woman’s endometrium is 2mm thick on USS. Do you biopsy?
> 4 mm no HRT
5mm on HRT
(only biopsy if >3mm)
Name one protective factor for endometrial cancer?
marina coil (progestogen only)
List the two criteria for primary amenorrhoea
no periods by 16 + secondary sexual characteristics
no periods by 14 + no secondary sexual characteristics
How is secondary amenorrhoea defined?
no periods for 6 months with pervious normal menstruation
What is thelarche?
breast tissue development
What is adrenarche?
pubic hair development
Which is the first sexual characteristic to develop?
breast enlargement
List two primary hypothalamic causes of amenorrhoea
anorexia nervosa
excessive exercise
stress
kallmann’s syndrome
constitutional delay
List two causes of secondary amenorrhea (hypothalamic)
anorexia nervosa
excessive exercise
stress
tumours
infections (TB)
Name one cause of anterior pituitary cause of amenorrhoea
hyperprolactinaemia (prolactin has negative feedback effect on hypothalamus)
primary- prolactinoma, pituitary hyperplasia
secondary- Sheehan’s syndrome
How does hypothyroidism cause amenorrhoea
Increased TSH promotes prolactin release, therefore negative feedback on GnRH
What are the adrenal causes of amenorrhoea?
cushing’s syndrome
androgen secreting syndrome
congenital adrenal hyperplasia (21-hydroxylase deficiency)
How does Cushing’s syndrome result in amenorrhoea?
raised cortisol has negative feedback on GNRH, decreasing oestrogen levels
What is the most common cause of primary amenorrhoea?
Turner’s syndrome
What is the most common cause of secondary amenorrhoea?
PCOS
Which criteria is used to diagnosed PCOS?
Rotterdam criteria
What does the rotterdam criteria consist of?
2/3
-PCO on US
-irregular periods
-hirsutism/excessive androgens/ biochemical findings
What happens to the levels of LH and FSH in PCOS?
Higher LH relative to FSH
Differentials/system for amenorrhoea?
ovarian
hypothalamus
thyroid
adrenal
ant pituitary
outflow obstruction
Name three hormones you would test for in the hormone profile of amenorrhoea
estrogen
progesterone
FSH
LH
Prolactin
Testoterone
TFTs
List three types of abnormal uterine bleeding
heavy menstrual bleeding
intermenstrual bleeding
postcoital bleeding
postmenopausal bleeding
amenorrhoea
List three questions you should ask in the history of patient with heavy menstrual bleeding
how long?
how many pads?
clots?
intermenstrual bleeding?
post coital bleeding?
List four differentials for heavy menstrual bleeding?
PALM COINE
Polyps
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Iatrogenic
Not yet classified
Endometrial
Which is the most common coagulopathy?
von willebrand disease
List three investigations for heavy menstrual bleeding
TFTs
FBC
Coag
Transvaginal US
Endometrial biopsy
List three options for management of heavy menstrual bleeding
tranexamic acid
NSAIDs
OCP
Mirena
Myomectomy
Hysterectomy
Uterine artery embolisation
