Amenorrhoea/ Dysmenorrhoea Flashcards
What are the causes of primary amenorrhoea?
o Turner’s syndrome
o Testicular feminisation
o Congenital adrenal hyperplasia
o Congenital malformations of the genital tract
What are the causes of secondary amenorrhoea?
o Hypothalamic amenorrhoea (e.g. Stress, excessive exercise)
o Polycystic ovarian syndrome (PCOS)
o Hyperprolactinaemia
o Premature ovarian failure
o Thyrotoxicosis
o Sheehan’s syndrome
o Asherman’s syndrome (intrauterine adhesions)
What are the signs and symptoms imperforate hymen?
o S/S: all other sexual characteristics developed, cyclical pelvic pain, amenorrhoea
o Ix: USS -> haematometra
What investigations do you do for amenorrhoea?
o b-HCG pregnancy
o Gonadotrophins hypothalamic cause (i.e. POI)
o Prolactin prolactinoma
o Androgens PCOS, CAH
o oestradiol pregnancy
o Thyroid function hypothyroid
Which type of amenorrhoea is more common?
Secondary (95%)
Epid: Primary 0.5%. Secondary 3%
What is the management of amenorrhoea?
Primary:
· Conservative management if constitutional delay.
· May require surgical correction of anatomy, reconstruction, psychological counselling, gender assignment, gonadectomy (high risk of malignancy if 46XY), bromocriptine (prolactinoma) treat eating disorder, hormone replacement.
Secondary:
· Depends on cause
· HRT if primary ovarian failure
· PCOS management see PCOS
· Surgical treatment if Ashermans, bromocriptine if prolactinoma, wt management, tx endocrine cause (i.e. Cushings or thyroid)
What is the biggest complication of amenorrhoea?
Osteoporosis
Other generic, malignancy etc.
What is the difference between primary and secondary amenorrhoea?
Primary: failure to reach menstruation by 16 (or no sexual characteristics or period by 14).
Secondary amenhorrea: absence of menstruation for >6 consecutive months in a woman with previous menses
What is dysmenorrhoea?
Painful periods.
What is the aetiology of dysmenorrhoea?
Primary: in absence of pathology. Often just after menarche.
Secondary: due to pathology. Endometriosis, adenomyosis, PID, pelvic congesiton syndrome, menhorragia, fibroids.
What is the epidemiology of dysmenorrhoea?
45% women in reproductive age. Primary youngs, secondary 20-30.
What would you find in the history of dysmenorrhoea?
Spasmic cramping in lower abdomen, may radiate to thighs and lower back.
Primary occurs with menstruation, in first 24h, then subsides.
Secondary may occur prior to and peak at time of menstruation.
What would you find in the examination of dysmenorrhoea?
Primary: abdominal and vaginal examination normal. Secondary: signs of pathology.
What is the pathology of dysmenorrhoea?
Primary: PGF2a causing uterine hypercontractility and myometrial ischaemia, contracitons cause further ischaemia. Secondary also probably related to PG.
What Ix would you do for dysmenorrhoea?
Microbiology: HVS, endocervical and chlamydia swabs,
Imaging: pelvic USS (fibroids/endometrial assessment)
Other: laporoscopy (endometriosis)
