Amenorrhoea

N91.0-2

• Description
• Medicine Treatment
• Referral

DESCRIPTION

Primary amenorrhoea: no menstruation by 16 years of age in the presence of secondary sexual characteristics.
Secondary amenorrhoea: amenorrhoea for at least 3 months in women with previous regular menses, or for at least 6 months in women with irregular cycles.

Investigations

• Body mass index.
• Urine pregnancy test.
• Pelvic ultrasound.
• Serum for TSH, FSH, LH, prolactin.
  • FSH>15 units/L in a woman <40 years of age suggests premature ovarian failure.
  • LH/FSH ratio of >2:1 suggests polycystic ovarian syndrome.

MEDICINE TREATMENT

For treatment of hyperprolactinaemia, hypo- or hyperthyroidism, see Endocrine System.

Progestin challenge test:

If no cause for secondary amenorrhoea is found:

• Medroxyprogesterone acetate, oral, 10 mg daily for 10 days.
  • Anticipate a withdrawal bleed 5–7 days following conclusion of treatment.

REFERRAL

• All cases of primary amenorrhoea.
• Secondary amenorrhoea not responding to medroxyprogesterone acetate.
• Polycystic ovarian syndrome and premature ovarian failure, for further evaluation.