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

  • General gynae (Suspected PCOS, Primary ovarian insufficiency (POI), Hypogonadism)
  • Endocrinology (Hyperprolactinaemia, Thyroid disease, Rare endocrine disorders)
  • Infertility Service (If trying to get pregnant)
  • 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  >10% of body weight loss- low FSH and LH
  • PCOS- FAI/LH/FSH/prolactin/TSH- see PCOS guidelines
  • Cervical Stenosis/intra uterine adhesions- From previous surgery - USS                                               
  • Pituitary tumour- Prolactin often >1000. Assess visual fields
  • Drugs- causing raised prolactin inc heroin/phenothiazines/metoclopromide/ tri-cyclics
  • Rare Endocrine Disorders- Cushing’s, Adrenal ca, Congenital Hyperplasia (testosterone >5) Sheehan’s syndrome (low prolactin)


Information to include in the referral:

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


Investigations - as above

  • FAI, LH, FSH, TFT, prolactin, SHBG
  • Pelvic USS

Offer Contraceptive advice to women who do not wish to become pregnant

If amenorrhoea persists for >12 months consider osteoporosis prophylaxis (http://cks.nice.org.uk/topics/amenorrhoea/management/secondary-amenorrhoea/#managing-osteoporosis-risk)


References:NICE CKS Ammenorhoea Revised November 2019

Author:Dr S Burns GP

Contributors: Miss S Bates Consultant Gynaecologist RCHT

Date: December 2020             Review date: December 2021