ABSTRACT

History Developmental history: reflects sexual hormone production. Presence/absence of cyclical symptoms: suggests ovarian function normal. History of chronic illness: inhibits hypothalamic-pituitary-ovarian axis. Excessive weight loss/eating disorder: inhibits hypothalamic-pituitary-ovarian axis. Excessive exercise: inhibits hypothalamic-pituitary-ovarian axis. Contraceptive history: menses on exogenous hormones may mask primary amenorrhoea. Reproductive history: pregnancy is the most common cause of secondary amenorrhoea. Menopausal symptoms and family history of premature menopause: a family history of premature ovarian failure may reflect a familial condition. Medications: can inhibit hypothalamic-pituitary-ovarian axis, e.g. gonadotrophin-releasing hormone (GnRH) analogues. Virilizing signs, galactorrhoea: suggests androgen-secreting tumour, congenital adrenal hyperplasia (CAH), prolactinoma. Hirsutism, acne: may be suggestive of polycystic ovarian syndrome (PCOS). (12 marks)

Examination Height: short stature may be associated with chromosomal abnormality, e.g. Turner’s syndrome. Weight/body mass index: polycystic ovary syndrome may be associated with raised BMI. Secondary sexual characteristics/evidence of virilization: may reflect PCOS or androgen-secreting tumour. Visual fields: homonymous hemianopia associated with pituitary tumour. Pelvic examination: imperforate hymen, absent pelvic organs. (5 marks)

2 Write short notes on the five stages of puberty. The events that occur in changes from a child to adult female usually occur in the following sequence:

1 Growth spurt. 2 Breast development. 3 Pubic hair growth. 4 Menstruation. 5 Axillary hair growth.