Sexual Health - Secondary Amenorrhoea Flashcards
What is secondary amenorrhoea?
No menstruation for more than 3 months after previous regular menstrual periods
When should investigation be considered for secondary amenorrhoea?
3-6 months
In women with previous infrequent irregular periods, 6-12 months
What are the causes of secondary amenorrhoea?
Pregnancy most common cause
Menopause and premature ovarian failure
Hormonal contraception
Hypothalamic or pituitary pathology
PCOS
Asheman’s syndrome
Thyroid pathology
Hyperprolactinaemia
What may cause the hypothalamus to reduce production of GnRH in hypogonadotropic hypogonadism?
Excessive exercise
Low body weight and eating disorders
Chronic disease
Psychological stress
What are the pituitary causes of secondary amenorrhoea?
Pituitary tumours e.g. prolactinoma
Pituitary failure- due to trauma, radiotherapy, surgery or Sheehan syndrome
How does hyperprolactinaemia cause secondary amenorrhoea?
High prolactin acts on the hypothalamus to prevent release of GnRH
Without GnRH, no release of LH and FSH
Caused by pituitary adenoma
How is a prolactinoma treated?
Dopamine agonists e.g.
Bromocriptine or cabergoline
How is secondary amenorrhoea assessed?
Detailed history and examination
Hormonal blood tests
USS to diagnose PCOS
What hormone tests are done for secondary amenorrhoea?
Beta human chorionic gonadotropin (hCG)
LH and FSH
PRL
TSH
Raised testosterone (PCOS, AIS, CAH)
How is secondary amenorrhoea managed?
TREAT UNDERLYING CAUSE
Replacement hormones
What do women with PCOS require every 3-4 months?
Withdrawal bleed
Reduces risk of endometrial hyperplasia and endometrial cancer
Medroxyprogesterone for 14 days or regular use of COCP to stimulate withdrawal bleed
Outline osteoporosis in patients with amenorrhoea
Associated with low oestrogen levels
Amenorrhoea lasts more than 12 months
- Ensure adequate vitamin D and calcium
- Hormone replacement therapy or COCP
