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
• Bimanual

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

Question 6

when would you suspect PCO?

Answer 6

1- PCO morphology on scan
2- 2 clinical or biochemical signs of hyperandrogegism
3- Oligoamenorrhoea or anovulation

Question 7

Complications of PCO?

Answer 7

• Higher risk of diabetes and CVS

- Risk of endometrial hyperplasia

Question 8

Management of PCO?

Answer 8

• WEIGHT loss
• Antiandrogen
• Endometrial protection : CHC, PROGESTERONE, MIRENA IUS