11th April 2024

Secondary Amenorrhoea

Secondary Amenorrhoea is defined as the absence of menstruation for 3-6 months in a patient with previous regular menses or 6-12 months in patients with oligomenorrhoea.

Causes of secondary amenorrhoea	Features
Pregnancy	Physiological androgen levels, confirmed with β-hCG test
Premature ovarian insufficiency (POI)	Females under 40 years old with premature menopausal symptoms (such as amenorrhoea or oligomenorrhoea) with elevated FSH levels on two samples 4-6 weeks apart
Functional hypothalamic cause	Physiological androgen levels Leads to suppression of the hypothalamic-pituitary-ovarian axis and suppression of gonadotrophin-releasing hormone Risk factors include stress and over-exercise
Cushing’s syndrome and exogenous androgen-producing tumours	Secondary amenorrhoea results from hypercortisolism. Negative feedback to the hypothalamus leads to decreased GnRH release.
Prolactinoma	Presents with galactorrhoea due to prolactin’s suppressive effect on GnRH production from the hypothalamus. Microprolactinomas are more common than macroprolactinomas. The latter may be suspected if clinical signs of raised intracranial pressure are present. Diagnosis is confirmed with an MRI pituitary.
Hyperprolactinaemia secondary to medication	Presents with galactorrhoea due to prolactin’s suppressive effect on GnRH production from the hypothalamus. First-generation antipsychotics are the most common cause, though second-generation antipsychotics may also cause hyperprolactinaemia. Other causes include oral contraceptives, metoclopramide, verapamil, and opiates.
Asherman’s syndrome	Characterised by scar tissue in the uterine cavity and may present as oligomenorrhoea or amenorrhoea and infertility History of dilatation and curettage and normal gonadotrophins

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