Amenorrhoea Flashcards
(33 cards)
Causes of primary amenorrhoea
Turners syndrome Imperforate hymen Hyperandrogenism - congenital adrenal hyperplasia delayed puberty Mullerian agenesis Low BMI
Causes of secondary amenorrhoea
Pregnancy Contraception Sheehan's syndrome Stress - BMI/ exercise Hyperthyroidism PCOS Prolactinoma
Investigations of amenorrhoea
Bloods - TFTs, FSH, LH, androgens, oestrogen, prolactin
USS
Karyotyping
Oligomenorrhoea definition
The duration between cycles is more than 35 days but less than 6 months
Secondary amenorrhoea
Not had a period after 3 months if cycles were normally regular or 6 months if irregular with oligomenorrhoea
Investigations for secondary amenorrhoea
Pregnancy test
Bloods - FSH, TSH, Prolactin
FSH normal:
- USS
Definition of primary amenorrhoea
Not starting menstruation by:
- 13 years with no evidence of pubertal development
OR
By 15 yo where there are other signs of puberty
When should normal puberty occur
Age 8 – 14 in girls
Age 9 – 15 in boys
Female puberty
- Breast buds - thelarche
- Pubic hair
- Menarche
Types of hypogonadism
- Hypogonadotropic hypogonadism
- Hypergonadotropic hypogonadism
Hypogonadotropic hypogonadism
Deficiency of LH and FSH released from the pituitary gland
Hypergonadotropic hypogonadism
Lack of response to LH and FSH by the gonads (the testes and ovaries)
Causes of hypogonadotropic hypogonadism
Hypopituitarism
Damage to the hypothalamus/ pituitary - radiotherapy/ surgery
Chronic conditions can temporarily delay puberty (e.g. cystic fibrosis or inflammatory bowel disease)
Excessive exercise or dieting
Constitutional delay in growth and development
Growth hormone deficiency, hypothyroidism, Cushing’s or hyperprolactinaemia
Kallman syndrome
Causes of hypergonadotropic hypogonadism
Previous damage to the gonads (e.g. torsion, cancer or infections such as mumps)
Congenital absence of the ovaries
Turner’s syndrome (XO)
Kallman syndrome
Pubertal delay and anosmia
Congenital adrenal hyperplasia pathophysiology
Congenital deficiency of the 21-hydroxylase enzyme.
Causing an underproduction of cortisol and aldosterone, and overproduction of androgens from birth
Inheritance pattern of congenital adrenal hyperplasia
Autosomal recessive
Presentation of congenital adrenal hyperplasia
Tall for their age
Facial hair
Absent periods (primary amenorrhoea)
Deep voice
Early puberty
Androgen Insensitivity Syndrome pathophysiology
Tissues are unable to respond to androgen hormones (testosterone)
Presentation of androgen insensitivity syndrome
Female phenotype - female external genitalia and breast tissue with male internal sexual organs (testes)
Types of structural pathology
Imperforate hymen
Transverse vaginal septae
Vaginal agenesis
Absent uterus
Female genital mutilation
Investigations for primary amenorrhoea
Bloods:
- FBC, ferritin -anaemia
- U&E - CKD
- Anti-TTG or anti-EMA antibodies -coeliac disease
- TFTs
- Insulin-like growth factor I - screening test for GH deficiency
Hormonal blood tests assess
Genetic testing with a microarray test
Imaging
Hormonal blood tests for primary amenorrhoea
FSH and LH will be low in hypogonadotropic hypogonadism
High in hypergonadotropic hypogonadism
Prolactin -hyperprolactinaemia
Testosterone - PCOS, androgen insensitivity syndrome and congenital adrenal hyperplasia
Genetic testing with a microarray test
Turner’s syndrome (XO)
