dr khaldoun khamaiseh mrcp frcog consultant obstetrician & … · 2020. 3. 18. · surgery:...
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Dr Khaldoun Khamaiseh MRCP FRCOG
Consultant Obstetrician & Gynecologist and Reproductive endocrinologist
Menarche occur between 11-14 years of age
Regular menstruation indicates that the hypothalamo–pituitary–ovarian axis is intact
Cycles between 23 and 35 days indicates ovulation.
The luteal phase is fixed(14 days) and the follicular phase is variable
Diagnosed when there is amenorrhoea in girls up to age of 14 years of age who have no secondary sexual characteristics.
Or, when there is amenorrhoea in girls up to age of 16 yrs with normal secondary sexual characteristics.
Defined as absent periods for at least six months in a woman who has previously had regular periods
hirsutism
menopausal symptoms
headache or visual disturbance – suggestive of CNS tumor such as craniopharyngioma
anosmia – one of the causes is Kallmans syndrome
chronic systemic illness, chemotherapy, radiotherapy
Chromosomal : Turner, fragile X syndrome
Hypothalamic: Kallman’s syndrome
Pituitary: Hypogonadotrohic hypogonadism
(Levi Lorraine syndrome)
Congenital uterine hypoplasia/Aplasia
(Meyer Rokitansky Kuster Hauser Syndrome)
Anorexia nervosa
Testicular feminization syndrome: XY male karyotype, normal breast development, short vagina, absent uterus, gonads should be removed agfter puberty to prevent dysgerminoma
Late onset congenital Adrenal hyperplasia: Severe hirsutism and amenorrhoea
Ovarian in origin 40% (PCOS, ovarian failure)
Hypothalamic 35% (Hyperprolactinaemia, Sheehan’s, pituitary necrosis due severe PPH)
Uterine in origin. 5% (Asherman’s syndrome)
Iatrogenic
Severe systemic illness: Renal failure, Endocrine
Secondary amenorrhoea can follow destruction and scarring of the endometrium and/or cervical canal resulting from postpartum curettage.
Typically, multiple synechiae may be seen on hysteroscopy.
Asherman's syndrome has been reported following generalised pelvic infection.
Treatment Hysteroscopic lysis of adhesions . Up to 80% of
patients can conceive following treatment but pregnancy is frequently complicated by premature labour, abnormal placentation (accrete/praevia) and postpartum haemorrhage.
Antipsychotics
Chemotherapy
Radiotherapy
Illicit drug use e.g. cocaine and opiates
Primary or secondary,
Age of the woman.
take a history, examine then requesting the appropriate investigations
Rule out physiological cause: Pregnancy , Lactation and menopause.
Irregular menstrual cycles – associated with polycystic ovary syndrome
malaise, fatigue, anorexia, weight loss – may be due to chronic illness
headaches – may be suggestive of CNS tumor
galactorrhoea – may be due to prolactinoma
H/O postpartum hemorrhage – may be associated with Sheehans syndrome
H/O dilataion and curretage – may be associated with Ashermans syndrome
Drugs: Contraception, antidepressants and antipsychotics, Chemotherapy
General Weight, height, body mass index (BMI) Blood pressure, thyroid,
Dysmorphic signs
Tanner staging: Breast, axillary and pubic hair stages
The woman's height and weight should be recorded.
Raised BMI is associated with polycystic ovarian syndrome
Reduced BMI with stress, anorexia nervosa.
Male pattern baldness and features of virilisation may be due to androgen secreting tumors of the ovary.
Assess for galactorrhoea by doing a breast examination.
Look out for features of hypothroidism.
Abdomen/pelvis Mass arising from pelvis
Perineum Inspection
Under anaesthesia, vaginoscopy, hysteroscope or cystoscope,
Pregnancy test
FSH & LH.
PCOS
TURNER SYNDROME
ovarian failure
Pituitary failure, anorexia
Prolactin levels
Testosterone levels , DHEA & Androstenodione
Estrogen and progesterone challenge tests.
Ultrasound and MRI
hysteroscopy and laparoscopy
Karyotyping in premature ovarian failure,
HRT. Estrogen and progesterone
Dopamine agonists: cabergoline,bromocriptine,
Surgery: Reconstructive, adhesiolysis
Thank you
A- first pregnancy in a woman's life.
B- Last period in the woman's life
C- First period in woman's life
D- Painful periods
E- Heavy periods
A- protein
B- Steroid
C- Lipid
D- Glycoprotein
E- Glycolipid
A- Ovarian failure
B- Addisons disease
C- Hyperthyroidism
D- Hyperprolactinaemia
E- Diabetes
A- High estrogen
B- Low FSH and LH
C- High progesterone
D- High FSH and LH
E- Non of the above
A- Continuous combined HRT
B- Estrogen only HRT - oral tablets
C- Estrogen only HRT - patches
D- Sequential combined HRT
E- Tibolone
a. chronic renal failure.
b. Galactorrhea.
c. Cimitidine therapy.
d. Methyldopa therapy.
e. Adrenogenital syndrome.
7- Recognised causes of raised FSH
a. Polycystic ovarian syndrome
b. Anorexia nervosa
c. Premature ovarian failure
d. Kallman's syndrome
e. All of the above
8- Concerning the menstrual cycle:
a- New endometrial growth starts during menstruation
b- Ovulation coincides with LH peak
c- Menstruation occurs following estrogen withdrawal
d- Is not ovualtory if the cycle is short
e- Is always prolonged if high prolactin level is present
9- Premature ovarian failure
a. The incidence is 5%
b. It may be associated with
hypothyroidism
c. Ovarian biopsy is essential to confirm
the diagnosis
d. Spontaneous pregnancy never occurs
e. Primary amenorrhoea occurs in 90% of
cases
10- All the following are features of Turner's syndrome, except
a. Cystic hygroma
b. Lymphoedema
c. Coarctation of the aorta
d. Cubitus varus
e. kyphoscoliosis
11- One of the following causes only primary amenorrhoea
A- Polycystic ovarian syndrome
B- Hyperprolactinaemia
C- Mullerian agenesis
D- Chemotherapy
D-Turner syndrome
12- Testicular fenminization syndrome(Androgen insensitivity) is a cause of primary amenorrhoea, the karyotype is
A- XO
B- XX
C- XY
D- XXX
E- XXY
A- Reduces the incidence of respiratory distress
syndrome
B- Reduces the incidence of intraventricular
hemorrhage
C- Used between 26 -34 weeks gestation
D- Betamethasone and dexamethasone may be given
E- Contraindicated in uncontrolled DM because it causes
severe hyperglycemia
a. The donar twin develops oligohydramnios and intrauterine growth restriction b. The recipient twin is at more risk of intrauterine fetal death c. Fetal hydrops develops in the donor twin d. Fetoscopic laser ablation is an established treatment e. Should be managed by fetal medicine specialist
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