5.1 Menstrual disorders

Question 1

define primary amennorhoea

Answer 1

failure to establish menstruation by 15 in normal secondary sexual characteristics, or 13 if not

Question 2

define secondary amennorhoea

Answer 2

cessation of menstruation for 3-6 months in women with previously normal periods, or 6-12 if oligomenorrhoea if not

Question 3

causes of primary amenorrhoea with normal secondary sexual characteristics

Answer 3

-imperforate hymen
-vaginal septum
-absent vagina
-absent uterus

Question 4

causes of primary amenorrhoea without normal secondary sexual characteristics

Answer 4

-chromosomal/hormonal cause e.g turner syndrome
-hypothalamic pituitary dysfunction e.g. constitutional, isolated GnRH deficiency

Question 5

hormone levels in turner syndrome

Answer 5

low oestrogen
high FSH LH

Question 6

causes of primary amenorrhoea with incongruous pubertal development

Answer 6

-androgen insensitivity syndrome (XY but female external)

Question 7

causes of secondary amenorrhoea

Answer 7

-stress, eating disorder
-hypo/hyperthyroidism
-PCOS
-prolactinoma
-cushings, Addisons, adrenal tumour
-cervical stenosis

Question 8

causes of physiological secondary amenorrhoea

Answer 8

-preganacy
-breast feeding
-contraception
-menopause

Question 9

triad for PCOS

Answer 9

menstrual irregularity, androgen excess (hirsutism, acne, hair loss), obesity

Question 10

diagnosis of PCOS

Answer 10

infrequent/no menstruation
high testosterone
US scan for polycystic ovaries

Question 11

management of PCOS

Answer 11

lifestyle advice
screen for T2DM
cyclical progesterone

Question 12

how do hyper and hypo thyroid affect periods?

Answer 12

usually
hyper: fewer
hypo: heavy

Question 13

what’s functional hypothalamic amenorrhoea?

Answer 13

weight loss and excess exercise, emotional stress
in gymnasts, athletes
risk of bone loss due to low oestrogen

Question 14

cause of oligomenorrhoea

Answer 14

-PCOS
-thyroid dysfunction
-eating disorders/excess exercise
-hormonal contraception
-perimenopuase

Question 15

what are uterine fibroids?

Answer 15

begin tumours of SMCs and fibroblasts in myometrium

Question 16

risk factors for leiomyoma

Answer 16

-age (until menopause)
-early menarche
-older age at pregnancy
-family history

Question 17

red flags in menorrhagia

Answer 17

-post menopausal bleeding
-ascites
-pelvic mass
-postcoutal bleeding

Question 18

management of dysfunctional uterine bleeding

Answer 18

FBC!!!!!
-IUS
-tranexamic acid/ NSAID
-combined pill/ progesterone only

Question 19

compare types of dysmenorrhoea

Answer 19

primary: 6-12 months after menarche, production of uterine prostaglandins during menstruation

secondary: after years of OK periods, caused by underlying pelvic pathology, pelvic inflammatory disease or IUD

Question 20

test for endometriosis

Answer 20

laparoscopy

Question 21

risk factors for endometriosis

Answer 21

-early menarche
-late menopause
-delayed pregnancy
-smoking
-family history
-low BMI

Question 22

complications of endometriosis

Answer 22

-adhesions
-chronic pain
-infertility
-endometriomas
-reduced QoL

Question 23

management of primary amenorrhoea

Answer 23

NSAID/paracetamol
oral contraceptive
conservative advice

Question 24

management of secondary amenorrhoea

Answer 24

manage symptoms
surgical if fertility priority
referral of red flag symptoms