Amenorrhoea Flashcards Preview

B - Gynaecology > Amenorrhoea > Flashcards

Flashcards in Amenorrhoea Deck (55)
1

What is amenorrhoea?

The absence of menstrual periods

2

How can amenorrhoea be classified?

- Primary
- Secondary

3

What is oligomenorrhoea?

Irregular periods with intervals between menstrual cycles of more than 35 days and/or less than 9 periods per year

4

What is primary amenorrhoea?

Failure to commence menses

5

When can primary amenorrhoea be diagnosed in girls 14+?

In the absence of secondary sexual characteristics

6

When can primary amenorrhoea be diagnosed in girls 16+?

In the presence (or absence) of secondary sexual characteristics

7

What are some examples of secondary sexual characteristics?

- Pubic hair
- Breast development

8

What is secondary amenorrhoea?

When there is cessation of periods for > 6 months after menarche

9

Can causes of secondary amenorrhoea cause primary amenorrhoea?

Almost always, if they are established before menarche

10

What are some specific causes of primary amenorrhoea in the presence of secondary sexual characteristics?

- Constitutional delay
- Genitourinary malformations
- Testicular feminisation (androgen resistance syndrome)
- Hyperprolactinaemia

11

What is constitutional delay of menarche?

Where there is no abnormality but the girl is a little later than her peers in reaching menarche

12

What is a useful part of the history in identifying constitutional delay of menarche?

History of menarche in mother and sisters

13

What genitourinary malformations can lead to primary amenorrhoea in presence of secondary sexual characteristics?

- Imperforate hymen
- Transverse vaginal septum
- Absence of uterus or vagina

14

What karyotype does androgen resistance syndrome occur in?

XY

15

What is the external appearance in androgen resistance syndrome?

Normal adolescent girl

16

What is the internal appearance in androgen resistance syndrome?

No female internal organs and gonads are testosterone producing testes

17

How can the presentation of androgen resistance syndrome vary?

On the degree of androgen sensitivity

18

What can cause hyperprolactinaemia leading to primary amenorrhoea?

- Hypothyroidism
- Medication
- Pituitary tumours

19

What medications can lead to hyperprolactinaemia leading to primary amenorrhoea?

Phenothiazines

20

What can cause primary amenorrhoea in the absence of secondary sexual characteristics?

- Ovarian failure
- Other causes of failure of the HPA
- Causes of ambiguous genitalia

21

What can cause ovarian failure leading to primary amenorrhoea?

- Chemotherapy
- Irradiation
- Chromosomal gonadal abnormality
- Developmental abnormality

22

What chromosomal abnormality can lead to primary amenorrhoea?

Turner's syndrome

23

What developmental abnormality can lead to primary amenorrhoea?

Mullerian agenesis

24

What can cause failure of the HPA leading to primary amenorrhoea?

- Tumours
- Irradiation
- Infection
- Head injury

25

What can cause ambiguous genitalia leading to primary amenorrhoea?

- Androgen secreting tumours
- Congenital adrenal hyperplasia

26

What is the most common cause of secondary amenorrhoea in women of childbearing age?

Pregnancy

27

What are the causes of secondary amenorrhoea with no signs of androgen excess?

- Physiological causes
- Premature ovarian failure
- Depot and implant contraception
- Cervical stenosis and intrauterine adhesions (Asherman's syndrome)
- Hypothalamic dysfunction
- Loss of weight
- Pituitary disease and hyperprolactinaemia
- Thyroid disease
- Iatrogenic

28

What are the physiological causes of secondary amenorrhoea?

- Pregnancy
- Lactation
- Menopause

29

What can be the causes of premature ovarian failure leading to secondary amenorrhoea?

- Autoimmune
- Radiotherapy
- Chemotherapy

30

What can cause hypothalamic dysfunction leading to secondary amenorrhoea?

- Stress
- Excessive exercise
- Eating disorders
- Depression
- Chronic systemic illness
- Tumours

31

What can cause pituitary disease and hyperprolactinaemia leading to secondary amenorrhoea?

- Medication
- Recreational drugs

32

What are the iatrogenic causes of secondary amenorrhoea?

- Medication
- Surgery
- Irradiation
- Chemotherapy

33

What surgeries can lead to secondary amenorrhoea?

- Hysterectomy
- Endometrial ablation
- Ovarian surgery

34

What are some signs of androgen excess in women?

- Hirsutism
- Acne
- Virilisation

35

What are some causes of secondary amenorrhoea in the presence of signs of androgen excess?

- PCOS
- Cushing's syndrome
- Late-onset congenital adrenal hyperplasia
- Adrenal or ovarian carcinoma

36

What % of amenorrhoea cases can be caused by PCOS?

30%

37

What should be asked about in the history when assessing amenorrhoea?

- Duration
- Contraception - recent and current
- Vasomotor symptoms
- Galactorrhoea
- Exercise habits
- Stresses
- Medication history
- PMH

38

What features should be looked for on examination in amenorrhoea?

- BMI
- Signs of excessive androgens
- Signs of thyroid disease or Cushing's syndrome

39

What investigations should be made into amenorrhoea?

- Pregnancy test
- FSH and LH
- Prolactin
- Total testosterone and sex hormone-binding globulin
- TFTs
- Pelvic USS

40

What types of pregnancy test are available?

Urine or serum hCG

41

When are FSH and LH raised in amenorrhoea?

Ovarian failure

42

What can low FSH or LH suggest as the cause of amenorrhoea?

Constitutional delay or hypothalamic cause

43

What might raised testosterone indicate as the cause of amenorrhoea?

- Androgen secreting tumour
- Late-onset CAH

44

When might slightly elevated testosterone levels be seen?

PCOS

45

In what condition might pelvic ultrasound be helpful?

PCOS

46

When should a pelvic ultrasound be performed to check for normal anatomy?

In young girls who are not sexually active

47

What may be appropriate for some women in terms of investigation for amenorrhoea?

Referral and additional investigation

48

What additional investigations may be appropriate for some women with amenorrhoea?

- Karyotyping
- MRI or CT
- Hysteroscopy

49

When might karyotyping be appropriate in amenorrhoea?

To exclude Turner's syndrome, testicular feminisation, and rare conditions

50

When might MRI or CT be appropriate in amenorrhoea?

Where pituitary tumour is suspected

51

When might hysteroscopy be appropriate in amenorrhoea?

In suspected Asherman's syndrome

52

What does the management of amenorrhoea depend on?

Underlying cause and priorities of the woman

53

What should be done in women with amenorrhoea and low oestrogen levels/

Assess for the risk of osteoporosis

54

What conditions cause amenorrhoea and low oestrogen levels?

- Premature ovarian failure
- Hypothalamic causes
- Hypopituitarism
- Hyperprolactinaemia

55

What should be done in women with amenorrhoea at risk of osteoporosis?

Ensure they have adequate calcium and vitamin D intake