Which of the following condition is not associated with amenorrhoea?

NORCET 3 - 2022 (Shift-2)

Obstetrics & Gynaecology

Hard

Appeared in: NORCET 3 - 2022 (Shift-2)

Explanation

Obesity is the condition least associated with amenorrhoea among the given choices.
It is more commonly linked with other menstrual irregularities like oligomenorrhoea (infrequent periods) and heavy menstrual bleeding, particularly in the context of Polycystic Ovary Syndrome (PCOS).
The mechanism in obesity often involves chronic anovulation due to hormonal imbalances (like insulin resistance and excess androgens), which leads to irregular cycles rather than a complete and sustained absence of menstruation.

Option A: Hyperprolactinemia is a classic and direct cause of amenorrhoea. Elevated prolactin levels inhibit the hypothalamic-pituitary-ovarian axis, suppressing ovulation and leading to the cessation of menses.
Option B: Antipsychotic medications, particularly dopamine antagonists, are a well-known iatrogenic (drug-induced) cause of hyperprolactinemia, which in turn leads to amenorrhoea.
Option C: Anorexia nervosa is a primary cause of functional hypothalamic amenorrhoea. The severe energy deficit and low body weight suppress GnRH pulsatility, shutting down the reproductive axis.

Visual 1: Flowchart: Diagnostic algorithm for evaluating amenorrhoea, starting with ruling out pregnancy, followed by tests for TSH, prolactin, and FSH.
Visual 2: Diagram: The Hypothalamic-Pituitary-Ovarian (HPO) axis, showing how factors like high prolactin or low GnRH can disrupt the cycle and cause amenorrhoea.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Causes of secondary amenorrhoea as background academic context rather than a clinical decision trigger.
For a nurse, the most critical first step in evaluating amenorrhoea is to rule out pregnancy, regardless of the patient's stated sexual history.
When taking a patient's history, it is vital to ask about all medications, including prescribed and over-the-counter drugs, as many can affect the menstrual cycle (e.g., antipsychotics, antiemetics).
Patient education is key. For patients with amenorrhoea due to anorexia, nurses must explain the serious long-term health risks, including osteoporosis and infertility, and encourage entry into a multidisciplinary treatment program.

How to Approach the Question

Identify the core concept: The question asks to identify the condition that is NOT a typical cause of amenorrhoea (absence of periods).
Analyze each option's relationship with the menstrual cycle.
Recall or deduce that hyperprolactinemia (high prolactin) directly inhibits ovulation, causing amenorrhoea.
Connect antipsychotics to hyperprolactinemia, making them an indirect but strong cause of amenorrhoea.
Recognize that anorexia nervosa (severe low weight) causes hypothalamic suppression, a classic cause of amenorrhoea.
Evaluate obesity: While it can cause menstrual issues, it's more characteristically associated with irregular or infrequent periods (oligomenorrhoea) due to anovulation (as in PCOS), not necessarily a complete absence of periods.

Concept Tested & Keywords

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