| Show Learning Points most relevant to Phase 1: |
Amenorrhoea
| 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 2Applied 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
- 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)
- 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
- 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
- Epidemiology of PCOS
- Epidemiology of POF
Conditions to be considered relating to this scenario
Common
polycystic ovarian syndrome, hypothalamic amenorrhoea
polycystic ovarian syndrome, hypothalamic amenorrhoea
Less common but 'important not to miss'
hyper/hypothyroidism, prolactinoma, primary ovarian failure, panhypopituitarism, anorexia nervosa
hyper/hypothyroidism, prolactinoma, primary ovarian failure, panhypopituitarism, anorexia nervosa
Uncommon
congenital adrenal hyperplasia, craniopharyngioma, empty sella syndrome, Asherman syndrome, Kallman's syndrome
congenital adrenal hyperplasia, craniopharyngioma, empty sella syndrome, Asherman syndrome, Kallman's syndrome
