Secondary Amenorrhoea

Question 1

Define secondary Amenorrhoea?

Answer 1

She’s had periods in the past but not in the last 6 months

Question 2

What are the possible causes of secondary amenorrhoea?

Answer 2

Pregnancy
Contraception
PCOS
Premature menopause
Prolactinoma
Hypothalamic Stress e.g. wt change or exercise
Androgen secreting tumour
Sheehan’s syndrome (pit failure)
Asherman’s Syndrome (intrauterine adhesions)
Significant endocrine diseases e.g. thyroid or cushing’s

Question 3

What signs can we look for to explain secondary amenorrhoea?

Answer 3

Take BP & BMI
Look for sings of androgen excess e.g. Hirsutism, enlarged clitoris & deep voice
Acne & cushingoid signs
Abdo Exam

Question 4

What tests can we do to explain secondary amenorrhoea?

Answer 4

Urine pregnancy test & glucose dipstick

FSH, LH, oestradiol, prolactin, TFTs & testosterone

Pelvic US (for PCOS)

Question 5

How can we treat secondary amenorrhoea?

Answer 5

Aim to get the BMI to 20-25
Assume they’re still fertile and require contraception
Emotional support
Check for fragile bones (low oestrogen -> Osteoporosis)

Treat the cause, if its premature ovarian insufficiency that means HRT till they hit 50 and menopause would begin anyway