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
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.
- Past gynae Hx inc surgery
- Significant PMHx
Investigations - as above
Consider FAI, LH, FSH, TFT,prolactin
Reference- Amenorrhoea- Patient Plus article from patient.co.uk
No Greentop guidance available