Primary Amenorrhoea Flashcards
what is the definition of primary amenorrhoea?
- no menstruation by 13 if no other evidence of pubertal development
- no menstruation by 15 if other signs of puberty
what is oligomenorrhoea?
>35 days in between periods
outline normal puberty in girls
- 8-14years
- starts with breast bud development, then pubic hair then menstruation
what are the causes of primary amenorrhoea?
- hypogonadism
- androgen insensitvity syndrome
- congenital adrenal hyperplasia
- anatomical abnormalities
- constitutional delay in growth & development
outline the classification of hypogonadism?
- hypogonadotrophic hypogonadism
- deficiency in LH&FSH
- hypergonadotrophic hypogonadism
- gonads fail to respond to LH&FSH, therefore no negative feedback and even more release of FSH&LH
what does hypogonadism mean?
lack of sex hormones (oestrogen + testosterone)
aetiology of hypogonadotrophic hypogonadism?
- hypopituitarism
- damage to pit/hypothalamus (cancer, radiotherapy)
- excessive dieting/ exercise
- Kallman syndrome
- significant chronic conditions
- endocrine disorders
what is kallman syndrome assoc w?
anosmia
aetiology of hypergonadotrophic hypogonadism?
- previous damage to gonads ie cancer, torsion, mumps
- congenital absence of uterus
- Turner’s syndrome
what is congenital adrenal hyperplasia and how does it present?
congenital deficiency in 21-hydroxylase enzyme so reduced cortisol and aldosterone and increased androgens
presentation: at puberty with absent periods, tall, facial hair & deep voice
anatomical abnormalities?
- imperforate hymen
- vaginal agenesis
- absent uterus
- transverse vaginal septae
Ix?
initial…
- FBC
- UE
- Anti TTG/anti-EMA
hormonal blood tests:
- TFT
- LH & FSH
- ILGF1
- testosterone
- prolactin
Genetic testing for turner’s
Imaging
- X-ray wrist- assess bone age
- MRI head
- pelvic US
Mx?
- treat underlying cause
- if hypogonadotropic hypogonadism:
- pulsatile GnRH - fertility preserving
- COCP- no fertility
