Amenorrhoea Flashcards
(31 cards)
What is primary amenorrhoea
No periods until 16 years if sexual secondary characteristics are present.
No periods until age 14 and absence of secondary sexual characteristics
What is secondary amenorrhoea
Lack of period occuring after normal menses have begun
What defines amenorrhoea
> 6 months between periods
What defines oligomenorrhoea
> 6 weeks < 6 months no period
Causes of secondary amenorrhoea
Physiological
Drugs
Hypothalamic or pituitary causes
Ovary
OUtflow tract problems
Sex disorders
What physiological conditions can cause amenorrhoea
Pregnancy or lactation
Which drugs can cause amenorrhoea
Contraceptives or steroids
What hypothalamic conditions can cause amenorrhoea
Over exercise, anorexia nervosa, Kallman syndrome and tumours
What pituitary conditions can cause amenorrhoea
Adenoma, Sheehan’s syndrome, surgery
Ovarian causes of amenorrhoea
PCOS, premature ovarian failure, ovarian dysgenesis (Turners)
What outflow tract problems can cause amenorrhoea
Imperforate hymen, transverse vaginal septum, mullerian agenesis - MRKH syndrome
What sex disorders can cause amenorrhoea
Androgen insensitivity syndrome and Swyer syndrome
What is the criteria for PCOS
- Amenorrhoea or oligoamenorrhoea
- Clinical signs
- Polycystic ovaries on US
What is polycystic ovary syndrome
Multifactorial disease causing hyperandrogenism with clinical signs such as hirsutism and acne, with amenorrhoea or oligomenorrhoea
Risk factors for PCOS
Maybe genetic - Chr 2 and 9
Environmental factors - south asia has higher prevalence
Obesity
Premature adrenarche
What is the pathophysiology behind the symptoms of PCOS
The cause of insulin resistance is from susceptibility to a decrease in glucose tolerance.
Hyperandrogenism is from high testosterone and low SHBG
There is a hormonal imbalance with increase in LH:FSH ratio and decreased FSH secretion. There is no negative feedback of these hormones.
Symptoms of PCOS
Menstrual irregularity, hirsutism, acne, alopecia, polycystic ovaries, overweight (pre-diabetic)
What is classes as polycystic ovaries on US
Presence of 12 or more follucles in one or both ovaries +/- increased ovarian volume
Associated co-morbidities of PCOS
Impaired glucose tolerance
CVD
endometrial cancer
OSA
Infertility
Depression/anxiety
NAFLD
Obesity/metabolic syndrome
Investigations into PCOS
Total testosterone
Sex-hormone binding globulin (SHBG)
Free androgen levels
+/- pelvis USS
Rule out other causes with - LH, FSH, prolactin and TSH
Lifestyle modifications for PCOS
Smoking cessation
Calorie restricted diet
Exercise
Treatment of oligoamenorrhoea in PCOS
Recommended to induce withdrawal bleed every 3-4 months at least, and if there is endometrial thickening the patient should have endometrial sampling. Use POP, COCP, mirena or IUS
Treatment of hirsutism
COC, finasteride, spironolactone, cyproterone acetate, flutamide, eflornithine, and mechanical methods such as shaving or waxing
Treatment of anovolatory infertility
Weight loss if BMI >30
Clomiphene citrate
Gonadotrophins
Ovarian drilling
Aromatase inhibitors
