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Obs and Gyne > Amenorrhoea > Flashcards

Amenorrhoea Flashcards

(49 cards)

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1
Q

What is primary amenorrhoea?

A

No periods:

  • <16 if secondary sexual characteristics present
  • <14 if no secondary sexual characteristics
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2
Q

What is secondary amenorrhoea?

A

Menstruation previously occurred but stopped >6 months

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3
Q

What are the causes of primary amenorrhoea when secondary sexual characteristics are present? (5)

A
  • Constitutional Delay
  • Genitourinary malformation
  • Androgen resistance syndrome (XY karyotype)
  • Hyperprolactinaemia
  • Pregnancy
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4
Q

What are the causes of primary amenorrhoea when secondary sexual characteristics are absent? (3)

A
  • Ovarian failure
  • Hypothalmic failure
  • HPA axis failure
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5
Q

What are the causes of ovarian failure? (4)

A
  • Chemo
  • Radiation
  • Chromosomal gonadal abnormality (turners)
  • Developmental abnormality (Mullerian agenesis)
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6
Q

What are the causes of hypothalmic failure?

A
  • Chronic illness
  • Excessive exercise
  • Stress
  • Significantly underweight
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7
Q

What are the causes of HPA axis failure?

A
  • Tumours /irradiation/ infection/ head injury inv. hypothalmus or pituitary
  • Kallmanns syndrome
  • Prader willi syndrome
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8
Q

What are the features of Kallmanns syndrome?

A

Delayed or absent puberty + impaired sense of smell

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9
Q

What causes Kallmanns syndrome?

A

Hypogonadatropic hypogonadism - impairment of hypothalamus to release GnRH

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10
Q

Which hormone is lacking in Kallmanns syndrome?

A

GnRH

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11
Q

What are the causes of secondary amenorrhoea when there are no signs of androgen excess?

A
  • Pregnancy/lactation/menopause
  • Premature ovarian failure
  • Progesterone contraception
  • Weight loss
  • Pituitary disease/hyperprolactinaemia
  • Thyroid disease
  • Iatrogenic (medications, surgery, irradiation, chemo)
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12
Q

What are features of androgen excess? (3)

A

Hair growth
Acne
Development of male characteristics

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13
Q

What are the causes of secondary amenorrhoea when there are signs of androgen excess?

A
  • PCOS
  • Cushing’s
  • Adrenal/ovarian carcinoma
  • Late onset congenital adrenal hyperplasia
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14
Q

What would an FSH > 20 suggest in a pt with amenorrhoea?

A

Premature menopause

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15
Q

What would a low FSH and LH suggest in a pt with amenorrhoea?

A

Hypothalamic-pituitary cause of amenorrhoea

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16
Q

What would an increased prolactin suggest?

A

Stress
Hypothyroidism
Prolactinoma
Drugs

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17
Q

What drugs (and indications) cause an increased prolactin? (3)

A

Phenothiazines (antipsychotic)
Domperidone (antiemetic)
Metoclopramide (nausea/vomiting)

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18
Q

What would a testosterone >5 suggest? (2)

A

Androgen secreting tumour

Late onset congenital adrenal hyperplasia

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19
Q

What are the Rotterdam criteria?

A

2/3 to diagnose PCOS:
Polycystic ovaries on US
Oligo-ovulation or anovulation
Clinical/biochemical Signs of hyperandrogenism

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20
Q

What causes darkened skin (acanthosis nigricans) in PCOS?

Study These Flashcards
A

Hyperinsulinaemia

21
Q

What is the management of PCOS? (5)

Study These Flashcards
A
  • Weight loss (increases insulin sensitivity)
  • Metformin (increases insulin sensitivity)
  • Clomifene citrate (induce ovulation to conceive)
  • Ovarian drilling if not responding to Clomifene
  • COCP (control bleeding)
22
Q

What are the long term consequences of PCOS? (4)

Study These Flashcards
A
  • Gestational diabetes
  • T2DM
  • Cardiovascular disease
  • Endometrial cancer
23
Q

What are the causes of menorrhagia?

Study These Flashcards
A
  • Dysfunctional uterine bleeding (diagnosis of exclusion)
  • Copper coil
  • Fibroids
  • Endometriosis
  • Adenomyosis
  • Pelvic infection
  • Polyps
  • Endometrial carcinoma
    Other:
  • Hypothyroidism
  • Caogulation disorder
24
Q

What would an enlarged uterus on examination suggest?

Study These Flashcards
A

Fibroids or adenomyosis

25
What should you do if there is inter-menstrual bleeding or post-coital bleeding
Check smear history
26
In a 48 year old patient with menorrhagia who has failed medical therapy, what investigations are needed?
Transvaginal US Endometrial biopsy Outpatient hysteroscopy
27
What is the 1st line treatment of menorrhagia?
Mirena IUS
28
What are the management options for menorrhagia?
``` Drugs - Mirena - Tranexamic acid - Mefenamic acid - COCP - Progestogens IM Surgery - Endometrial ablation - Uterine artery embolisation - Myometomy - Hysterectomy ```
29
What is the average age of menopause in the UK?
52
30
What symptoms do women going through the menopause experience?
Menstrual irregualrity Vasomotor disturbance (sweats, palpitations, flushes) Atrophy of genitalia, breasts and skin Osteoporosis
31
What type of HRT should be given to women without a uterus?
Oestrogen only
32
What type of HRT should be given to women with a uterus who have had a period in the last 12 months?
Oestrogen and cyclical progesterone
33
What type of HRT should be given to women with a uterus who have not had a period in the last 12 months?
Continuous combined HRT
34
What are contraindications to HRT?
``` Oestrogen dependent cancer Past PE Undiagnosed PV bleeding High LFTs Pregnancy Breast feeding Phlebitis ```
35
What are fibroids?
Benign smooth tumours of the uterus
36
What percentage of women of reproductive age have fibroids?
20-40%
37
Wha are the risk factors for fibroids?
Increasing age Afro-carribean FH of fibroids
38
What other diseases are associated with fibroids?
Skin and uterine leiomyomata | Renal cell cancer
39
How and why does pregnancy affect fibroids?
Enlarge in pregnancy as they are oestrogen dependent | also COCP
40
When do fibroids atrophy?
After menopause
41
How can fibroids present?
``` Asymptomatic Menorrhagia Fertility problems Pain Mass ```
42
How do fibroids affect periods?
Menorrhagia | Not IMB/PMB
43
Why do fibroids cause fertility problems?
Submucosal fibroids interfere with implatation
44
When do fibroids cause pain?
Torsion of a pedunculated fibroid | Or thrombosis of the blood supply (red degeneration)
45
What symptoms may come up in a systems review in a patient with fibroids?
Large fibroids may cause: - increased urinary frequency (bladder) - Oedematous legs/varicous veins (veins)
46
What are the medical treatment options for fibroids?
GnRH analogues - goserelin SC monthly for 3-6 months prior to surgery to shrink fibroids Ullipristal acetate - Selective progesterone receptor modulator - Taken daily for 3-6 months to shrink fibroids and induce amenorrhoea prior to surgery
47
What are the surgical treatment options for fibroids?
``` Myomectomy - hysteroscopic - laparoscopic - open Uterine artery embolisation Hysterectomy ```
48
What is red degeneration of fibroids?
Thrombosis of capsular vessels, followed by venous engorgement and inflammation Causes abdo pain and localised peritoneal tenderness
49
How do you treat red degeneration of fibroids?
Bed rest and analgesia Should resolve over 4-7 days Plan C-section if large masses of fibroids are noted

Obs and Gyne (9 decks)

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