Flashcards in Amenorrhoea Deck (55)
What is amenorrhoea?
The absence of menstrual periods
How can amenorrhoea be classified?
What is oligomenorrhoea?
Irregular periods with intervals between menstrual cycles of more than 35 days and/or less than 9 periods per year
What is primary amenorrhoea?
Failure to commence menses
When can primary amenorrhoea be diagnosed in girls 14+?
In the absence of secondary sexual characteristics
When can primary amenorrhoea be diagnosed in girls 16+?
In the presence (or absence) of secondary sexual characteristics
What are some examples of secondary sexual characteristics?
- Pubic hair
- Breast development
What is secondary amenorrhoea?
When there is cessation of periods for > 6 months after menarche
Can causes of secondary amenorrhoea cause primary amenorrhoea?
Almost always, if they are established before menarche
What are some specific causes of primary amenorrhoea in the presence of secondary sexual characteristics?
- Constitutional delay
- Genitourinary malformations
- Testicular feminisation (androgen resistance syndrome)
What is constitutional delay of menarche?
Where there is no abnormality but the girl is a little later than her peers in reaching menarche
What is a useful part of the history in identifying constitutional delay of menarche?
History of menarche in mother and sisters
What genitourinary malformations can lead to primary amenorrhoea in presence of secondary sexual characteristics?
- Imperforate hymen
- Transverse vaginal septum
- Absence of uterus or vagina
What karyotype does androgen resistance syndrome occur in?
What is the external appearance in androgen resistance syndrome?
Normal adolescent girl
What is the internal appearance in androgen resistance syndrome?
No female internal organs and gonads are testosterone producing testes
How can the presentation of androgen resistance syndrome vary?
On the degree of androgen sensitivity
What can cause hyperprolactinaemia leading to primary amenorrhoea?
- Pituitary tumours
What medications can lead to hyperprolactinaemia leading to primary amenorrhoea?
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
What can cause ovarian failure leading to primary amenorrhoea?
- Chromosomal gonadal abnormality
- Developmental abnormality
What chromosomal abnormality can lead to primary amenorrhoea?
What developmental abnormality can lead to primary amenorrhoea?
What can cause failure of the HPA leading to primary amenorrhoea?
- Head injury
What can cause ambiguous genitalia leading to primary amenorrhoea?
- Androgen secreting tumours
- Congenital adrenal hyperplasia
What is the most common cause of secondary amenorrhoea in women of childbearing age?
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
What are the physiological causes of secondary amenorrhoea?
What can be the causes of premature ovarian failure leading to secondary amenorrhoea?