Female Physiology Problems

Question 1

What are the main causes of amenorrhea?

Answer 1

• Problems with regulating hormones
• Problems with ovarian function
• Problems with the uterus and outflow tract

Question 2

What are problems with regulating hormones?

Answer 2

Hypogonadotropic hypogonadism. Low FSH/LH or high prolactin:

• Functional – excessive weight change, overexercising or stress
• Chronic conditions – diabetes, sarcoidosis, renal disease, TB
• Neuro – prolactinoma, tumours and cysts
• Infection or trauma – meningitis, intracranial bleed, Sheehan’s
• Drugs – Glucocorticoids, anabolic steroids, opiates
• Genetic – Kallmann’s syndrome

Question 3

What are problems with ovarian function?

Answer 3

Hypergonadotropic hypogonadism.

• Primary ovarian insufficiency (POI) or premature ovarian failure (POF)
• Ageing – Decline in ovarian function >35 y/o
• Chronic conditions –autoimmune diseases
• Infection – TB, mumps, oophoritis
• Drugs – Radiotherapy, chemotherapy
• Genetic – Turner’s syndrome (46X), Fragile X

Question 4

What are problems with uterus/outflow tract?

Answer 4

Congenital
• Absent uterus or vagina
• Transverse vaginal septum or an imperforate hymen (Mullerian duct fails to canalise)
• Androgen insensitivity syndrome

Iatrogenic
• Uterine adhesions or synechiae
• Radiotherapy, either pelvic or cervical

Question 5

What is the management for amenorrhea?

Answer 5

• Lifestyle changes (if functional)
• Treatment of the cause (if organic)
• Fertility treatment (if treatment unsuccessful)