Gynaecology

Cards (25)

  • Amenorrhoea means absence of menstrual periods
  • Primary amenorrhea
    Absence of menses by 14 years of age in the absence of growth or development of secondary sexual characteristics or absence of menses by 16 years of age regardless of the presence of normal growth and development including secondary sexual characteristics
  • Secondary amenorrhea
    Cessation of menstruation in a woman who had experienced menstrual bleeding previously for three normal cycles or for 6 months
  • A study in India indicated that 11.1% of adolescent girls, who presented with gynaecological complaints of menstrual disorders, had primary amenorrhea. However, the incidence of the disease in women in general is less than 1%
  • Menstrual bleeding
    1. Circulating oestrogen (oestradiol) levels stimulate endometrial proliferation
    2. Progesterone from corpus luteum transforms proliferating endometrium into secretory
    3. If pregnancy does not occur, secretory endometrium sheds as menstrual bleeding
  • Normal menstrual cycle
    • Normal functioning hypothalamus (GnRH)
    • Normal functioning pituitary glands (FSH, LH)
    • Normal functioning ovaries (oestrogens, progesterone)
    • Normal endometrial development
    • Intact outflow tract
  • Compartments for aetiological classification of amenorrhea

    • Disorders of the outflow tract (uterus and vagina)
    • Disorders of the ovary
    • Disorders of the anterior pituitary
    • Disorders of the CNS
  • Mullerian agenesis
    Mayer Rokitansky Kuster Hauser (MRKH) syndrome - Absent uterus and vagina, normal ovaries and karyotype 46XX
  • Mullerian agenesis
    • Phenotype of normal female with normal height and secondary sexual characteristics, short and blind vagina
    • Associated with renal (20%) and skeletal (12%) anomalies
    • Diagnosis by ultrasound and karyotyping
    • Treatment is delayed until patient is ready for sexual activity, usually needs vaginoplasty
  • Imperforate hymen

    Obstructive congenital anomaly of female genital tract, incidence 1 in 2000 female births
  • Imperforate hymen
    • Girls present with cyclic abdominal pain, dysuria, acute urinary retention
    • Bluish bulging hymen on examination
    • Definitive treatment is hymenotomy or hymenectomy
  • Transverse vaginal septum
    Abnormality in vertical fusion of vaginal components of Mullerian ducts and urogenital sinus, incidence 1 in 50,000-70,000 females
  • Transverse vaginal septum
    • Girls present with cyclic lower abdominal pain, palpable lower abdominal mass
    • Associated with other congenital anomalies in 37-60% cases
    • Treatment is excision of vaginal septum
  • Cervical agenesis
    Abnormal fusion of Mullerian ducts with urogenital sinus or atrophy of normally formed Mullerian system, incidence 0.01% in general population
  • Cervical agenesis
    • Rarely associated with functioning uterus and vagina
    • Attempts at correcting using Foley's catheter usually fail, may end in hysterectomy
  • Androgen insensitivity syndrome
    Inherited X-linked trait with 46XY karyotype, testes producing normal androgens but absence of cytosol receptor
  • Androgen insensitivity syndrome
    • Feminized external genitalia at birth, adequate breast development but nil or scanty axillary and pubic hair at puberty
    • Testes removed after puberty or prepubertal gonadectomy with oestrogen replacement therapy
    • Majority have short vagina, may need vaginoplasty
  • 5α reductase deficiency
    Autosomal recessive sex-limited disease with 46XY karyotype, ambiguous genitalia at birth
  • 5α reductase deficiency
    • Uterus and fallopian tubes absent, testes intact
    • Pubertal gynaecomastia may occur
    • Gonadectomy and oestrogen replacement therapy given
  • Gonadal dysgenesis
    Inhibition of indifferent embryonic gonads to differentiated gonads, includes pure gonadal dysgenesis, mixed gonadal dysgenesis, Turner syndrome
  • Turner syndrome
    • Most common cause of delayed puberty and primary amenorrhea, occurs in 1 in 2500 to 1 in 3000 live born girls
    • Karyotype 45X, may have mosaicism 46XX/45X or 46XY/45X
    • Classic features are short stature, web neck, cubitus valgus, low hairline, shield chest, widely placed nipples
    • Associated with cardiovascular abnormalities like coarctation of aorta and bicuspid aortic valves
  • Gonadal dysgenesis

    A variety of diseases in which the development of the indifferent embryonic gonads to differentiated gonads is inhibited
  • Types of gonadal dysgenesis
    • Pure gonadal dysgenesis (46, XX or 46, XY = Swyer syndrome)
    • Mixed gonadal dysgenesis (mosaic 45,X0/46,XY etc.)
    • Turner syndrome
  • Turner syndrome
    The most common cause of delayed puberty and primary amenorrhoea, occurring 1 in 2500 to 1 in 3000 live born girls, with karyotype 45X
  • Turner syndrome

    • Classic features: short stature, web neck, cubitus valgus, low hairline, shield chest and widely placed nipples
    • Associated abnormalities: cardiovascular, renal, autoimmune hypothyroidism