Amennorhea Flashcards
What is primary amenorrhoea?
Primary amenorrhoea is defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics, or by 13 years of age in girls with no secondary sexual characteristics.
What is secondary amenorrhoea?
Secondary amenorrhoea is the cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea.
What are common causes of primary amenorrhoea?
Common causes include gonadal dysgenesis (e.g. Turner’s syndrome), testicular feminisation, congenital malformations of the genital tract, and congenital adrenal hyperplasia.
What are common causes of secondary amenorrhoea?
Common causes include functional hypothalamic amenorrhoea (e.g. secondary to anorexia), polycystic ovarian syndrome (PCOS), hyperprolactinaemia, and premature ovarian failure.
What initial investigations are done for amenorrhoea?
Initial investigations include excluding pregnancy with urinary or serum bHCG, full blood count, urea & electrolytes, coeliac screen, thyroid function tests, and gonadotrophins.
What do low and raised gonadotrophin levels indicate?
Low levels indicate a hypothalamic cause, while raised levels suggest an ovarian problem, such as premature ovarian failure or gonadal dysgenesis.
What is the management for primary amenorrhoea?
The management includes investigating and treating any underlying cause, and hormone replacement therapy may be beneficial for primary ovarian insufficiency due to gonadal dysgenesis.
What is the management for secondary amenorrhoea?
Management involves excluding pregnancy, lactation, and menopause, and treating the underlying cause.
What is an ectopic pregnancy?
Implantation of a fertilized ovum outside the uterus
Ectopic pregnancies commonly occur in the fallopian tubes.
What is a typical history of a female with an ectopic pregnancy?
History of 6-8 weeks amenorrhoea, lower abdominal pain, and later vaginal bleeding
Amenorrhoea refers to the absence of menstruation.
What is usually the first symptom of ectopic pregnancy?
Lower abdominal pain
This pain is due to tubal spasm.
How is the abdominal pain typically described in ectopic pregnancy?
Constant and may be unilateral
Unilateral means affecting one side.
What are the characteristics of vaginal bleeding in ectopic pregnancy?
Usually less than a normal period and may be dark brown in colour
This bleeding may indicate complications such as ruptured ectopic pregnancy.
What does a history of recent amenorrhoea in the context of ectopic pregnancy typically indicate?
Typically 6-8 weeks from the start of the last period
If longer, it may suggest other causes like inevitable abortion.
What are potential signs of peritoneal bleeding in ectopic pregnancy?
Shoulder tip pain and pain on defecation/urination
These symptoms occur due to irritation of the diaphragm.
What other symptoms may be seen in ectopic pregnancy?
Dizziness, fainting, or syncope
These symptoms may be due to internal bleeding.
What examination findings may be present in ectopic pregnancy?
Abdominal tenderness, cervical excitation, adnexal mass
Cervical excitation is also known as cervical motion tenderness.
What does NICE advise regarding the examination for an adnexal mass in suspected ectopic pregnancy?
Do NOT examine for an adnexal mass due to increased risk of rupturing the pregnancy
A pelvic examination to check for cervical excitation is recommended.
What serum bHCG level points toward a diagnosis of ectopic pregnancy in cases of pregnancy of unknown location?
Serum bHCG levels >1,500
Elevated bHCG levels are indicative of pregnancy but need further investigation in this context.
