Secondary amenorrhoea

Question 1

Systems review

Answer 1

General: weight loss, stress, exercise, diet
Head: visual problems, headaches
Thyroid: any symptoms
Torso: Galactorrhoea, hirsutism, acne
Abdomen: possibility of pregnancy

Question 2

Gynaecological causes

Answer 2

Pregnancy
PCOS
Menopause/premature ovarian failure

Question 3

Premature ovarian failure

Answer 3

Sweats/flushes, aches and pain, previous erratic menstrual cycle, emotional changes
SAMPlE

Question 4

Endocrine causes

Answer 4

Hypothalamic amenorrhoea
Cushing’s syndrome
Hyperprolactinemia

Question 5

Hypothalamic amenorrhoea

Answer 5

Extreme anxiety, stress of exertion
Poor diet,
Excessive weight loss
Low BMI

Question 6

Cushing’s syndrome

Answer 6

Steroid use
Think skin/bruising
Central obesity and fat redistribution

Question 7

Hyperprolactinemia

Answer 7

Use of anti-psychotics
Visual symptoms
Galactorrhoea
Infertility

Question 8

Other causes

Answer 8

Hyper/hypothyroidism
Severe systemic illness
Hypopituitarism/pituitary failure
Post-pill amenorrhoea