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Amenorrhea

Clinical Discipline(s)/Organ System(s)
Endocrinology, Obstetrics & Gynaecology, Reproduction & Development
Progress Test Topic(s)
Women's health
Description
A 21 year old NZ European woman is referred to a gynaecologist as she has not had her menses for the last 6 months. She is also troubled by increasing hair growth affecting her face.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Physiology of normal puberty and sexual maturity
   - Pathophysiology of the hypothalamic-pituitary-ovarian axis: hyperprolactinaemia, stress, anorexia, thyroid dysfunction
   - Pathophysiology of polycystic ovary syndrome (PCOS) and premature ovarian failure (POF)
   - Pharmacology of progestogens, combined oral contraceptive pill, metformin, anti-androgens
Clinical and Communication Skills 
   - Elicit a comprehensive gynaecological history (including menstrual history, sexual history), medical, surgical and obstetric history
   - Examination, including general (to recognise anorexia, visual field defects, secondary sexual characteristics and syndromes), abdomen and pelvis
   - Record the stage of pubertal development (Tanner stages)
   - Define amenorrhea and classify it as primary or secondary
   - Differential diagnosis of amenorrhoea
   - Diagnosis of PCOS according to Rotterdam criteria
   - Appropriate initial investigations: pregnancy test, gonadotrophins, prolactin, thyroid-stimulating hormone (TSH), swabs, smear
   - Indications for pelvic ultrasound, androgen profile, pituitary MRI
   - Complications of PCOS (infertility, long-term metabolic outcomes and risks to the endometrium)
   - Complications of hypothalamic amenorrhoea (infertility, osteoporosis)
   - Complications of POF (infertility, osteoporosis)
Personal and Professional Skills 
   - Consent for intimate examination and use of chaperone
   - Effectively communicate advice regarding lifestyle (e.g. smoking cessation)
   - Delivering life-changing news
Population Health 
   - Epidemiology of PCOS
   - Epidemiology of POF
Conditions to be considered relating to this scenario
Common
polycystic ovarian syndrome, hypothalamic amenorrhoea
Less common but 'important not to miss'
hyper/hypothyroidism, prolactinoma, primary ovarian failure, panhypopituitarism, anorexia nervosa
Uncommon
congenital adrenal hyperplasia, craniopharyngioma, empty sella syndrome, Asherman syndrome, Kallman's syndrome
Related Scenarios
[Infertility]