W1 - Amenorrhoea Flashcards
what are the 3 physiological causes of amenorrhoea
prepuberty
pregnancy
menopause
what is primary amenorrhoea
amenorrhoea in girls >14 years without secondary sexual characteristics.
OR
no menarche by 16 with normal secondary sexual characteristics
what is secondary amenorrhoea
menses have ceased for longer than 6 months without any physiological reason.
what are the most common causes of primary amenorrhoea
Gonadal dysgenesis (43%)
Mullerian agenesis (15%)
Constitutional (14%)
PCOS (7%)
what are com causes of the hypothalamus stopping menstruation
stress, depression, exercise, anorexia nervosa, chronic systemic illness and weight loss
what can cause primary amenorrhoea due to the pituitary
Pituitary tumours,
Hydrocephalus,
Craniopharyngioma,
Empty sella syndrome
Prolactinoma
what can cause primary amenorrhoea due to the ovaries
Turners
Gonadal dysgenesis
Premature ovarian failure
what can cause primary amenorrhoea due to the vagina and uterus
Mullerian ageneis – Mayer-Rokitansky-Kuster-hauser syndorme
Outflow obstruction
Imperforated hymen
Transverse septum
what medications can cause amenorrhoea
antipsychotics, chemotherapy, radiotherapy, illicit drug use e.g. cocaine and opiates
what is Mayer-Rokitansky-Kuster-Hauser syndrome
causes of primary amenorrhoea
Vagina is absent or hypoplastic.
The uterus is usually absent
urological tract - unilateral renal agenesis, pelvic kidney, horseshoe kidney, hydronephrosis, ureteric duplication
Ovarian development and function is normal
which areas are the most common cause of secondary amenorrhoea
40% ovarian
35% hypothalamic
5% uterine
what are some hypothalamic causes of amenorrhoea
stress, depression, exercise, anorexia nervosa, chronic systemic illness and weight loss
what are some ovarian causes of secondary amenorrhoea
Premature ovarian failure
Polycystic ovary syndrome
Chromosomal abnormalities such as fragile X and Turners mosaic
Radiation
Chemotherapy
what are some uterine causes of secondary amenorrhoea
Ashermans syndrome
(curettage, infection)
Cervical stenosis
what are some pituitary causes of secondary amenorhoea
Head injury
Sheehans syndrome
Prolactinoma
Encephalitis
what should you check on examination in a case of amenorrhoea
BMI
BP - cushings
thyroid - goitre
androgens - hirsutism
secondary sex characteristics
breast examination
abdominal exam
pelvic exam
what investigations can be done in amenorrhoea
HCG levels - pregnancy
Hormonal levels - FSH/LH, Testosterone, thyroid, prolactin, oestrogen, DHEA, FAI, SHBG
Ultrasound (TAS, TVS), MRI
Karyotyping
Laparoscopy
Hysteroscopy
Hystersalpingography
what is an imperforate hymen
Failure of complete canalization of the vagina
how does an imperforate hymen present
cyclical abdominal pain, abdominal swelling and urinary retention
On examination - bluish bulging membrane
