amenorrhoea

Question 1

what can amenorrhoea be divided into?

Answer 1

primary or secondary

Question 2

what is primary amenorrhoea?

Answer 2

failure to start menses by age of 16

Question 3

what is secondary amenorrhoea?

Answer 3

cessation of established, regular menstruation for 6 months or longer

Question 4

what are the causes of primary amenorrhoea?

Answer 4

1. consitutional delay
   
   • late bloomer, has 2˚ sexual characteristics
2. Turner’s syndrome
   
   • XO chromosome
3. testicular feminisation syndrome
   
   • XY genotype, no internal female organs
4. congenital adrenal hyperplasia
5. Kallmann syndrome
   
   • failure to secrete GNRH
6. congenital malformations of the genital tract
   
   • imperforate hymen
   • mullerian agenesis

Question 5

what are the causes of secondary amenorrhoea (after excluding pregnancy)?

Answer 5

1. menopause
2. contraception
3. lactational amenorrhoea
4. hypothalamic amenorrhoea (e.g. stress, excessive exercise)
5. PCOS
6. hyperprolactinaemia
7. premature ovarian failure
8. thyrotoxicosis*
9. Sheehan’s syndrome
10. Asherman’s syndrome (intrauterine adhesions)

*hypothyroidism may also cause amenorrhoea

Question 6

what are the initial ix done for amenorrhoea?

Answer 6

1. urinary / serum bHCG
   
   • exclude pregnancy
2. gonadotrophins
   
   • low levels = hypothalamic cause
   • high levels = ovarian problem e.g. premature ovarian failure
3. prolactin
4. androgen levels
   
   • raised levels in PCOS
5. oestradiol
6. TFTs