Clinical investigations from the RACP

Investigating primary and secondary amenorrhoea

Clinical investigations from the RACP

Investigating primary and secondary amenorrhoea

Michelle Wellman

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Abstract

Most cases of amenorrhoea can be evaluated by taking a careful history, performing a physical examination and measuring hormone levels. Diagnostic imaging is useful in some women.
Correction
A correction for this article was published in the December 2015 issue of Medicine Today. The full text PDF for this article (see link above) has been corrected.

Key Points

  • Amenorrhoea is often physiological and readily apparent, related to pregnancy, lactation or menopause, and further investigation is not necessary.
  • Most cases of nonphysiological amenorrhoea are due to polycystic ovary syndrome (PCOS), hyperprolactinaemia, primary ovarian insufficiency (POI) or hypothalamic amenorrhoea.
  • Specialist referral is essential for women presenting with primary amenorrhoea, Asherman’s syndrome and POI.
  • PCOS is common and can be managed in general practice, with referral for management of infertility if necessary.
  • Girls presenting with primary amenorrhoea are more likely to have a chromosomal or anatomical abnormality than older women.
  • Amenorrhoea in younger women is often accompanied by considerable anxiety regarding fertility; counselling may be required.

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