Secondary Amenorrhoea

Question 1

What is the difference between primary and secondary amenorrhoea?

Answer 1

Primary amenorrhoea - never had a period

Secondary amenorrhoea - usually has periods but none for the last 6 months

Question 2

What can cause secondary amenorrhoea?

Answer 2

Pregnancy/breast feeding
Contraception related - current use or for 6-9 months after depo-provera
Polycystic ovaries
Early menopause
Thyroid disease/cushings/any significant illness
Raised prolactin - prolactinoma/medication related
Hypothalamic - stress/wt change/exercise
Androgen secreting tumour - testosterone >5 mg/l
Sheehans syndrome - pituitary failure
Ashermans syndrome - intrauterine adhesions

Question 3

How should you investigate secondary amenorrhoea?

Answer 3

Measure BMI
Look for androgenic signs e.g. hirsutism, acne, enlarged clitoris, deep voice
Abdominal/bimanual examination
Urine pregnancy test
Urine dipstick for glucose
Bloods
- FSH
- oestradiol
- thyroid function
- prolactin
- testosterone
Pelvic ultrasound

Question 4

Is it safe to assume a woman with secondary amenorrhoea is infertile?

Answer 4

No - assume she is fertile and needs contraception unless 2 years after confirmed menopause

Question 5

How can PCOS be managed?

Answer 5

Weight loss/exercise
Antiandrogens
- CHC
- spironolactone
- eflornithine cream facial hair
Endometrial protection
- CHC
- progestogens
- Mirena IUS
Fertility medications
- clomiphene (ovulatory stimulant)
- metformin