18.     Secondary amenorrhoea.

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MCQ Paper 1

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    (See also MCQ2, question 11 & MCQ 5, question 35.)

a. may be due to hyperprolactinaemia True
b. is often due to stress False
c. should be treated with the combined oral contraceptive False
d. may be due to  Ascherman's syndrome True
e. may follow cone biopsy True
f. may be due to thyrotoxicosis True

Stress is always quoted as a cause of secondary amenorrhoea.

But is one of the less common causes in practice and very much down the list compared to weight loss and excessive exercise. 

Treatment will depend on the underlying cause and may vary from doing nothing to removing a hormone secreting ovarian tumour. 

Cervical stenosis may occur after cone biopsy.

This would cause cryptomenorrhoea - see MCQ3, question 26.

There is usually a history of cyclical pre-menstrual symptoms and dysmenorrhoea.

Haematometra (uterus full of blood - c.f. haematocolpos: vagina full of blood) can usually be seen on scan. 

Asherman's syndrome is intra-uterine adhesions due to over-curettage, particularly of a pregnant uterus.

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