Amenorrhoea | Notion

Premature Ovarian Failure

Amenorrhoea may be divided into:

primary: defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development), or by 13 years of age in girls with no secondary sexual characteristics
secondary: cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea

Causes

Primary amenorrhoea	Secondary amenorrhoea (after excluding pregnancy)
• gonadal dysgenesis (e.g. Turner's syndrome) - the most common causes
• testicular feminisation
• congenital malformations of the genital tract
• functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
• congenital adrenal hyperplasia
• imperforate hymen	- hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)

polycystic ovarian syndrome (PCOS)
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis*
Sheehan's syndrome
Asherman's syndrome (intrauterine adhesions) |

Investigation and management

Initial investigations

exclude pregnancy with urinary or serum bHCG
full blood count, urea & electrolytes, coeliac screen, thyroid function tests
gonadotrophins
- low levels indicate a hypothalamic cause where as raised levels suggest an ovarian problem (e.g. Premature ovarian failure)
- raised FSH/LH if gonadal dysgenesis (e.g. Turner's syndrome)
prolactin
androgen levels
- raised levels may be seen in PCOS
oestradiol

Management

primary amenorrhoea:
- investigate and treat any underlying cause
- with primary ovarian insufficiency due to gonadal dysgenesis (e.g. Turner's syndrome) are likely to benefit from hormone replacement therapy (e.g. to prevent osteoporosis etC)
secondary amenorrhoea
- exclude pregnancy, lactation, and menopause (in women 40 years of age or older)
- treat the underlying cause
hypothyroidism may also cause amenorrhoea