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Phase 3A Medicine > Obgyn - amenorrhoea and infertility > Flashcards

Obgyn - amenorrhoea and infertility Flashcards

1
Q

Hypothalamus releases what hormone to pituitary in order for menstruation to occur?

A

Gonadotropin releasing hormone (GnRH)

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2
Q

Pituitary releases what hormones to induce menstruation?

A

FSH LH

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3
Q

The ovarian follicle secretes what hormones in response to LSH and FH stimulation?

A

Oestrogen and progesterone

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4
Q

What causes menstruation?

A

Follicle stops secreting oestrogen and progesterone as pregnancy has not occurred. When very low (day 28) leads to menstruation

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5
Q

What is primary amenorrhoea?

A

No breast development by age 13 OR no menarche by age 15

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6
Q

What is secondary amenorrhoea?

A

Female started having periods and then stopped

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7
Q

What is the first investigation of primary and secondary amenorrhoea?

A

Pregnancy test

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8
Q

What scale is used to assess primary amenorrhoea after a pregnancy test has come back negative?

A

Tanner scale

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9
Q

What does the Tanner scale assess?

A

Pubic hair and breast development

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10
Q

What are the stages of the Tanner scale?

A
  1. Pre-pubertal - no breasts or hair
  2. Breast buds and soft hair
  3. Breast mounds and pubic hair course
  4. Breast enlargement mound on mound and hair covers pubic areas (MENARCHE)
  5. Breast takes on adult contour and hair extends to inner thigh
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11
Q

Primary amenorrhoea investigations?

A
  1. Pregnancy test
  2. Tanner scale
  3. Pelvic ultrasound (uterus?)
  4. Serum levels of FSH
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12
Q

On ultrasound for investigation of primary amenorrhoea, uterus was present and serum FSH was high. What does this suggest?

A

Gonadal dysgenesis. They didn’t develop properly in utero and have been replaced by streak gonads (can’t respond to FSH). E.g. TURNERS SYNDROME, SWYERS SYNDROME

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13
Q

Karyotype of Turners?

A

45X

or mosaic 45X, 46XX
45X, 46XY

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14
Q

Symptoms of Turners syndrome?

A 
Short stature
Wide or webbed neck
Broad chest
Widely spaced nipples
Low set ears
Arms turn outwards at the elbows
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15
Q

Why should streak gonads in patients with 46XY mosaicism in Turners be removed?

A

Risk of gonadoblastoma

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16
Q

Treatment of Turners

A

Oestrogen therapy which is gradually increased over 2-4 years to achieve normal pubertal growth and development

After 2 years of oestrogen start with progesterone for 10 days a month to induce bleeding

Growth hormone also helps with short stature

17
Q

Causes of primary amennorrhoea?

A
  1. Turners syndrome (high FSH)
  2. 17 alpha-hydroxylase deficiency (CAH) (high FSH)
  3. Hypothalamic-pituitary disorder (low FSH) e.g. Kallmann syndrome (congenital delay of puberty) or constitutional delay of puberty (family member the same)
  4. Anatomic abnormality e.g. imperforate hymen or transverse septum inside vagina
  5. Absent uterus - mulerian agenesis, complete androgen insensitivity
18
Q

What is secondary amenorhhoea?

A

3 consecutive skipped periods in individuals that previously had regular menstrual cycles OR 6 months of no bleeding in females who had irregular cycles

19
Q

Causes of secondary amenorrhoea?

A
  1. Contraceptive pills
  2. After stopped taking birth control
  3. Progestin releasing IUD
  4. Hypothyroidism
  5. Hyperprolactinaemia (can be secondary to prolactinoma OR DRUGS)
  6. PCOS
  7. Primary ovarian failure
20
Q

Treatment of hyperprolactinaemia secondary to prolactinoma?

A

Cabergoline (dopamine agonist)

21
Q

Individuals with secondary amenorrhoea with high testosterone (>60ng/dL) what is the most likley diagnosis?

A

PCOS

22
Q

Signs and symptoms of PCOS?

A
  1. Oligomenorrhoea/amenorrhoea
  2. Obesity
  3. Insulin resistance
  4. Hyperandrogenism
23
Q

Treatment of PCOS

A
  1. Oral contraceptive
    Or
    Spironolactone

If desire pregnancy - clomiphene citrate

24
Q

What is primary ovarian failure?

A

Ovarian follicles undergo accelerated atresia and get depleted before the menopause

25
Q

PCOS diagnosis

A

2 of 3 from:

High androgen
Irregular periods
Cysts on ovaries on TVUS

26
Q

Investigations of primary amenorrhoea

A
  1. Bloods (TFT, LH, FSH,

Phase 3A Medicine (12 decks)

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