Amenorrhoea

Putting the menstrual cycle into action - we discuss diagnosing and treating this common condition.

 

Lecture by

Video Duration: 21 minutes

  • Amenorrhoea
    Created by Paige Leigh Roberts
    General
    Epidemiology
    • Primary
      • Failure of menses to start by the age of 15 with appropriate development of secondary sexual characteristics.
      • Failure of acquisition of secondary sexual characteristics by the age of 14.
    • Secondary
      • Cessation of menses for greater than 6 months in pre-menopausal women.

    Secondary is much more common than primary

    Pathology

    None

    Top three causes
    • Primary
      • Mullerian agenesis
      • Outflow tract obstruction
      • Constitutional delay of puberty
    • Secondary
      • Pregnancy (ALWAYS rule out)
      • Endocrine
        • Hypogonadotropic hypogonadism
        • Hyper-gonadotropic hypogonadism
        • Normo-gonadotropic
      • Outflow tract obstruction
    Clinical Features
    Symptoms

    Lack of menstruation

    Signs
    • Primary
      • Lack of secondary sexual characteristics
      • Abnormalities of internal or external genitalia
    • Secondary
      • Dependent on cause
    Investigations
    Cultures

    B-HCG - always do this


    Bloods

    Gonadotrophins and oestradiol levels:

    • Hypogonadotropic hypogonadism - low FSH/LH and low oestradiol
    • Hypergonadotropic hypogonadism - high FHS/LH and low oestradiol
    • Normogonadotropic - normal FSH/LH and normal oestradiol

    Prolactin (low indicates pregnancy, hypothyroidism, drug-induced, high indicates prolactin secreting tumour)

    Testosterone (tumour)

    TFTs (hyperthyroidism)

    Dexamethasone suppression test (Cushing's)

    Imaging

    Transabdominal or transvaginal USS (structural abnormalities and PCOS)

    MRI (pituitary adenoma)

    Scopic/Biopsy

    None

    Functional

    Karyotyping (Turner's syndrome)

    Treatment
    Conservative

    None

    Medical

    Treatment of underlying cause

    Surgical

    May be necessary if due to fibroids