Menstrual Pathologies Flashcards
what is primary amenorrhoea
not starting menstruation by 13 if there is no signs of pubertal development or by 15 if there are signs of development
what is hypogonadotrophic hypogonadism
deficiency in LH and FSH
causes deficiency in sex hormones
what causes hypogonadotrophic hypogonadism
usually abnormal function of hypothalamus or pituitary SOL - prolactinoma, cysts, tumours hypopituitarism trauma - meningitis radiotherapy induced damage excessive dieting or exercise kallman syndrome (genetic, associated with anosmia) endocrine disorders
what is hypergonadotrophic hypogonadism
gonads do not respond to LH and FSH
high levels of LH and FSH, low sex hormone levels
what causes hypergonadotrophic hypogonadism
damage to gonads congenital absence of ovaries turners syndrome chronic illness radio/chemo infection - TB, mumps ageing
what are structural/uteral causes of primary amenorrhoea
FGM absent uterus imperforate hymen transverse vaginal septum androgen insensitivity syndrome asherman syndrome (iatrogenic, scarring)
what investigations could you do for amenorrhoea
threshold for investigation = 13 + no pubertal changes FBC - anaemia U&E - CKD anti-TTG or anti-EMA - coeliac FSH + LH levels TFTs insulin like GF for GH deficiency testosterone - raised in polycystic ovarian syndrome genetic tests MRI of brain - tumours pelvic US
how do you manage primary amenorrhoea
establish and treat cause replacement hormones if needed correct stress, poor diet etc pulsatile GnRH for hypo hypo replacement sex hormones - combined pill
what is secondary amenorrhoea
no menstruation for 3+ months after previous regular periods
what causes secondary amenorrhoea
pregnancy menopause premature ovarian failure contraception - IUS, POP hypothalamic or pituitary pathology polycystic ovarian syndrome thyroid pathology hyperprolactinemia stress low body weight chronic disease excessive exercise hyperprolactinaemia (prolactin inhibits GnRH)
how do you manage secondary amenorrhoea
find and treat underlying cause
consider osteoporosis risk associated with low oestrogen levels
