Amenorrhoea

Related Subjects: | Male Infertility | Sheehan's syndrome

Investigations of this condition may be divided according to whether secondary sexual characteristics are present or not. If absent, girls should be investigated at the age of 16. If present, investigation can wait until the age of 18.

Primary Amenorrhoea

• Primary Amenorrhoea - no period by age 16 though it may simply be the late onset of puberty.
• Is there normal sexual development and genitalia and signs of any inherited syndromes.
• Hypothalamic (absence of GnRH) or hypogonadatrophic (no LH or FSH)
• Idiopathic. Post radiotherapy or surgery. Craniopharyngiomas, Anorexia, Excessive exercise
• Congenital uterine or Vaginal abnormalities - Mullerian agenesis, imperforate hymen
• Chromosomal: Turner's syndrome, Androgen insensitivity syndromes
• Endocrine: Polycystic ovarian syndrome, Prolactinoma

Secondary Amenorrhoea

• Secondary Amenorrhoea - when periods cease > 6 months in a woman with previously normal periods.
• Always consider pregnancy as the first cause of secondary amenorrhoea.
• Consider hormonal (pituitary, adrenal, thyroid disease), premature ovarian failure, weight loss, systemic disease, Stress. Androgen secreting tumours, pituitary and hypothalamic tumours
• Clinical: Look for hirsuitism, galactorrhoea, lactation, drugs,

Investigations

• Pregnancy test for secondary amenorrhoea
• FSH - high in premature menopause.
• LH and Testosterone - raised in polycystic ovary disease.
• Cortisol high in Cushing's syndrome Dexamethasone suppression test
• Thyroid disease - TSH, T4
• Prolactin (prolactinomas)
• Karyotype - suspected chromosomal problem for primary amenorrhoea e.g Turner's syndrome
• USS: polycystic ovaries ? uterine thickness suggests oestrogen activity