Oligomenorrhea

Question 1

What’s primary amenorrhoea?

Answer 1

Is the absence of menses at 14 yrs with absence of secondary sexual characteristics or absence of menses at 16 yrs with presence of secondary sexual characteristics.

Question 2

What is secondary oligomenorrhea?

Answer 2

Is the cessation of menses for 6 months or for 3 cycle in an oligomenorrhic woman

Question 3

Pathological amenorrhoea

Answer 3

…

Question 4

Hypothalamic disorders causing Amenorrhoea

Answer 4

. Excessive weight loss and gain, stress
. Hypothalamic lesions e.g craniopharyngioma, glioma
explain….
. Head injuries
. Kallman’s syndrome
. Systemic disorder
. Drugs e.g progesterone, HRT or dopamine antagonists

Question 5

Pituitary disorders causing this

Answer 5

. Adenoma; most common prolactinoma
. Pituitary necrosis e.g Sheehan’s syndrome
. Iatrogenic damage
. Congenital failure of pituitary development

Question 6

Ovarian disorders causing it

Answer 6

. PCOS
. Premature Ovarian failure

Ovarian failure is the cause of hyper gonadotropic hypogonadism

Question 7

Define Premature Ovarian failure

Answer 7

Cessation of periods before 40yrs of age

Question 8

Endometrial disorders

Answer 8

. Mullerian defects eg Mayer-Rokitansky-Kuster-Hauser synonym
. Transverse ovarian septum
. Imperforate hymen
. Asherman’s Syndrome

Question 9

Management

Answer 9

. History
. Examination

Question 10

Investigations

Answer 10

. Pregnancy test
. LH, FSH and testosterone

Increase in LH and testosterone, PCOS significant
Increase in FSH, POF

. Level of prolactin
. USS
. Thyroid fxn
. MRI of Brain
. Hysteroscopy for Asherman or cervical stenosis
. Karyotyping

Question 11

Diagnosis of secondary amenorrhoea

Answer 11

. Progestin Challenge test
. Estrogen/Progesterone challenge test

Explain…