Amenorrhoea

Question 1

How is amenorrhoea classified?

Answer 1

PRIMARY
-Lack of menstruation by 16 yrs

SECONDARY
-Cessation of established menstruation > 6 months

Question 2

What are causes of PRIMARY amenorrhoea?

Answer 2

Turner’s syndrome
Testicular feminisation
Congenital adrenal hyperplasia
Congenital malformation of genital tract

Question 3

What are causes of SECONDARY amenorrhoea?

Answer 3

PHYSIOLOGICAL
Pregnancy
Lactation
Menopause
Progesterone only contraception
Continuous COCP use

HYPOTHAAMIC CAUSES

• Stress
• Anorexia
• Excessive exercise

DISEASE

• PCOS
• Thyrotoxicosis
• Hyperprolactinaemia
• Sheehan’s syndrome
• Asherman’s syndrome (intrauterine adhesions)
• Premature ovarian failure

Question 4

What initial investigations should be conducted for amenorrhoea?

Answer 4

bHCG to exclude pregnancy

Gonadotrophin levels

• Low = hypothalamic cause
• Raised = ovarian cause (premature failure)

Prolactin level
-hyperprolactinaemia

Androgen level
-Raised in PCOS

Oestrodiol

TFTs

Question 5

How should amenorrhoea be treated?

Answer 5

TREAT UNDERLYING CAUSES

• Cyclical withdrawal bleeds from COCP
• Obtain normal BMI
• HRT for premature failure
• Relief of genital outflow obstruction
• Specific treatment for endocrinopathies/tumours