primary amenorrhoea

Question 1

when do you consider someone to have primary amenorrhoea?

Answer 1

• if by 13 years they have no signs of pubertal development

- if by 15 they have other signs of puberty but have not started mensturating

Question 2

what are the 2 different types of hypogonadism?

Answer 2

hypogonadotrophic hypogonadism= deficiency in LH and FSH, as a result of an abnormal functioning hypothalamus or pituitary gland

Hypergonadotrophic hypogonadism= lack of response to LH and FSH by the testes or ovaries, as a result of absence or damage to gonads

Question 3

causes of primary amenorrhoea

Answer 3

• excess dieting/ anorexia
• kallman syndrome
• chronic disease
• Turner syndrome
• hypogonadotropic hypogonadism
• hypergonadotropic hypogonadism
• congenital adrenal hyperplasia
• Androgen insensitivity syndrome
• structural pathology

Question 4

what are some structural pathologies that can result in amenorrhoea?

Answer 4

• imperforate hymen
• transverse vaginal septae
• Vaginal agensis
• absent uterus
• FGM

Question 5

what type of symptoms do you present with if you have structural pathology?

Answer 5

cyclical abdominal pain as menses build up but are unable to pass through

Question 6

what tests should you do?

Answer 6

initial investigations to rule out chronic disease:
- FBC and ferritin for anaemia
- U and E for chronic kidney disease
Anti TTG and anti EMA for coeliac disease

Hormonal bloods testing:

• LH and FSH
• TFT
• insulin like growth factor (screening test for growth hormone deficiency)
• prolactin
• testosterone (raised in PCOS, androgen insensitivity syndrome and congenital adrenal hyperplasia)

imaging:

• Pelvic ultrasound
• MRI of the brain