Oligo-/Amenorrhoea

Question 1

List some causes of Oligomenorrhoea

Answer 1

Constitutional (woman just naturally has longer periods)

Anovulation (not ovulating during cycle):
PCOS
Thyroid disease
Prolactinoma
Congenital adrenal hyperplasia

Question 2

List 3 physiological causes of Amenorrhoea

Answer 2

Menopause
Pre-pubertal
Pregnancy

Question 3

List 4 causes of Primary Amenorrhoea

Answer 3

Delayed puberty
Eating disorder (Anorexia) / Excessive exercise / Stress / Chronic illness

Imperforate hymen / Transverse septum
Absent vagina
Mullerian agenesis (MRKH syndrome)

Androgen insensitivity (46, XY)
Turners syndrome (45, XO)

Primary ovarian failure // Premature menopause

Question 4

Outline the investigation pathway for Primary Amenorrhoea

Answer 4

Question 5

List 4 causes for Secondary Amenorrhoea

Answer 5

Pregnancy

PCOS
Premature menopause

Hysterectomy?
Ashermans syndrome (Uterine adhesions)

Sheehan syndrome (Hypopituitarism following haemorrhage after childbirth)
Prolactinoma

Eating disorder / Exercise induced / Stress / Chronic illness
Hypothyroidism
Cushings disease
Medication (eg Progesterone only pill)

Question 6

Outline the investigation pathway for Secondary Amenorrhoea

Answer 6

Question 7

What are the 3 Rotterdam criteria for PCOS?

Answer 7

1. Oligo-/Amenorrhoea
2. Clinical or Biological features of hyperandrogenism
3. Radiological findings (12 or more follicles; ovarian volume >10cm)

Question 8

What are the investigations for PCOS?

Answer 8

o Sex Hormone Binding Globulin (SHBG)
o Total testosterone
o FREE ANDROGEN INDEX (FAI)
o FSH, LH
o TFT
o Prolactin

Question 9

What is the management for PCOS?

Answer 9

Weight loss = mainstay

Withdrawal bleeds every 3 months (Medroxyprogesterone)

Treat ment depends on goals:
Regular periods = COCP
Wants to concieve = Clomiphene citrate
Acne/Hirsuitism = COCP; Laser hair removal; Acne treatments

Question 10

Name 4 long-term consequences/complications for PCOS

Answer 10

o Metabolic disorders (eg impaired glucose tolerance + T2DM)
o Cardiovascular disease
o Obstructive sleep apnoea
o Infertility, Recurrent miscarriages.
o Pregnancy complications (eg Pre-eclampsia & Gestational diabetes)
o Endometrial cancer – if not ovulating then progesterone levels remain relatively low therefore the endometrium is exposed to longer periods of unopposed oestrogen [3-4 monthly withdrawal bleeds reduces the risk]
o Psychological disorders (eg Anxiety & Depression)