Women's Health : Oligomenorrhea + amenorrhea Flashcards
What is oligomenorrhea?
Infrequent or irregular menstrual periods, variably defined as fewer than 6–8 periods per year.
Define amenorrhea.
The absence of a menstrual period.
What is primary amenorrhea?
○ Primary amenorrhea: absence of a period at age 15 in the presence of normal secondary sexual characteristics or at age 13 with no secondary sexual characteristics
Define secondary amenorrhea.
Secondary amenorrhea: absence of a period for three consecutive cycles in a woman with a previously established menstrual cycle.
List common causes of primary amenorrhea.
○ Constitutional delay (familial) ○ Imperforate hymen ○ Hypo- / hyperthyroidism, hyperprolactinaemia, Cushing’s syndrome ○ Androgen insensitivity syndrome ○ Turner’s syndrome
List common causes of secondary amenorrhea.
○ Functional Hypothalamic Amenorrhea - excessive exercise, weight loss, stress, eating disorders. ○ Premature ovarian insufficiency ○ Sheehan’s syndrome, prolactinoma, hypopituitarism ○ Hypo- / hyperthyroidism
What is PCOS?
An endocrinopathy characterized by ovarian cysts, oligomenorrhea, and hyperandrogenism.
What are the Rotterdam criteria for diagnosing PCOS?
a woman must meet 2 of the 3: 1. Hyperandrogenism 2. Oligo- or anovulation 3. Polycystic morphology on ultrasound
True or False: PCOS requires ovarian cysts for diagnosis.
False. PCOS can be diagnosed in the absence of ovarian cysts if other criteria are met.
Explain the disrupted hormonal balance in PCOS.
Disrupted balance between androgens, anti-Mullerian hormone and FSH levels leads to arrest in follicular development: a. Increased GnRH release frequency leads to high LH:FSH ratio. b. This results in high androgen:oestradiol ratio. c. Low oestrogen (due to reduced granulosa cell activity) prevents follicle selection and subsequent ovulation. Instead, multiple immature follicles remain and form cysts. d. Additionally, high androgens may inhibit sex steroid negative feedback on the HPG axis, leading to a ‘vicious circle’ of rising androgens
How does insulin resistance contribute to PCOS?
Insulin resistance and hyperinsulinaemia: a. Peripheral insulin resistance (skeletal muscle, adipose tissue) leads to hyperglycaemia and subsequent hyperinsulinaemia. b. High insulin levels stimulate theca cell androgen production and reduce sex-hormone binding globulin levels (SHBG); this means increased free circulating androgens.
List common symptoms of PCOS.
Hyperandrogenism: hirsutism, acne, hyperhidrosis. ● Oligomenorrhea - due to oligo-ovulation. ● Subfertility / infertility
Name risk factors for PCOS.
- Obesity 2. Family history 3. Premature adrenarche (pubic / axillary hair, apocrine sweat gland development).
Which investigations help diagnose PCOS?
- Total serum testosterone - elevated 2. Sex hormone-binding globulin (SHBG) - normal to low 3. Free androgen index - elevated 4. Rule-out tests: LH and FSH , prolactin, TFTs . 5. Imaging:
Which tests rule out PCOS?
LH and FSH (premature ovarian failure), prolactin (hyperprolactinaemia), TFTs (hypothyroidism); used to eliminate other causes of oligomenorrhea
