amenorrhoea

Question 1

what is primary amenorrhoea

Answer 1

failure to establish menstruation by age 15 in girls with normal secondary sexual characteristics
or by 13 in girls with no secondary sexual characteristics

Question 2

what is secondary amenorrhoea

Answer 2

cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea

Question 3

causes of primary amenorrhoea

Answer 3

gonadal dysgenesis (turners)
testicular feminisation
congenital malformations of the genital tract
functional hypothalamic amenorrhoea (anorexia)
congenital adrenal hyperplasia
imperforate hymen

Question 4

causes of secondary amenorrhoea

Answer 4

hypothalamic amenorrhoea (stress, excessive exercise)
PCOS
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis
sheehan’s syndrome
asherman’s syndrome

Question 5

initial investigations in amenorrhoea

Answer 5

exclude pregnancy
FBC, U&Es, coeliac, TFTs
gonadotrophins (low= hypothalamic cause, raised= ovarian problem)
prolactin
androgen levels (raised in PCOS)
oestradiol

Question 6

management of primary amenorrhoea

Answer 6

investigate and treat underlying cause
primary ovarian insufficiency benefit from HRT

Question 7

management of secondary amenorrhoea

Answer 7

exclude pregnancy, lactation and menopause
treat underlying