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Secondary Amenorrhoea

 

Definition- when menstruation has previously occurred but it has stopped for at least 6 consecutive months.

 

Consider the cause of the amenorrhoea to guide appropriate referral eg endocrinology/ infertility or pcos service/ general gynae/ eating disorders service.

 

Causes and investigations

 

Pregnancy- urinary or serum BHCG

Lactation

Menopause inc premature ovarian failure ie menopause <40yrs- raised FSH

Contraception- depot/ implant/ POP/ Mirena/ post pill amenorrhoea

Weight loss esp if rapid and BMI<19 and >10% of body weight has been lost- low FSH and LH

PCOS- FAI/LH/FSH/prolactin/TSH- see other guideline

Cervical Stenosis/intra uterine adhesions- USS                                               

Sheehan’s syndrome- low prolactin

Pituitary tumour- prolactin often in the thousands

Drugs- causing raised prolactin inc heroin/phenothiazines/metoclopromide/ tri-cyclics

Cushing’s /adrenal or ovarian carcinoma

Congenital hyperplasia- testosterone > 5- also consider an androgen secreting tumour if levels are this high

 

Information to include in the referral letter to Amenorrhoea and Adolescent Gynae Clinic:

  • History and examination inc menstrual Hx taking into consideration the possible cause.
  • DHx
  • BMI
  • Past gynae Hx inc surgery
  • Significant PMHx

 

Investigations - as above

Consider FAI, LH, FSH, TFT,prolactin

Pelvic USS

 

 

Reference- Amenorrhoea- Patient Plus article from patient.co.uk

No Greentop guidance available