Amenorrhoea

Primary never had a period

The most common cause is primary ovarian failure from a chromosomal abnormality
Not common but occasional reason for consultation
Aetiology
Chromosomal abnormality e.g. Turners syndrome with streak ovaries 45, XO,
mosaic forms (45%), 46X, 17 alpha hydroxylase deficiency with 46,XX
Hypothalamic dysfunction from stress, anorexia, hyperprolactinaemia, exercise
(30%), inadequate GnRH, poor synthesis, congenital defects, CNS neoplasms e.g.
craniopharngioma, NT defect, pituitary failure from isoloated gonadtrophin
insufficiency e.g. thalassaemia major, mumps, encephalitis,
Prepubertal hypothyroids
Retinitis pigmentosa
Androgen resistance, congenital absence of uterus
Anatomical abnormalities imperforate hymen (18%); normal secondary sexual
characteristics
Mx
Lack of breast development by the age of 14 requires early Ix with FSH and prolactin
assay
No periods by 16 requires specialist gynaecological clinic for pelvic US and
chromosomal studies
Reassure
Tx
Weighing and advice on diet, exercise to small, thin girls
Induction of secondary sexual development by HRT
Surg hymenectomy
HRT if Turners syndrome to allow normal sexual development
Note, most girls with Turners are dx at birth and good gynaecological care involves supervision
of HRT or COCP from 13
Secondary - commonest cause (cessation of periods for 6mths) is excessive exercise or dieting
after pregnancy is excluded
10% of young females may present with sx at some stage
Aetiology
Pregnancy
Weight loss or excessive exercise 38%
Polycystic ovaries 26%
Premature or perimenopausal 22%
Hyperprolactinaemia 11%
Dx
Weight and height measurement
Hx to exclude diet, exercise, menstrual pattern, hot flushes, galactorrhoea and hirsuitism
Ix
Exclude pregnancy
FSH, LH
Serum prolactin and TH
Pelvic US to check for polycystic ovaries and endometrial thickness
 Refer if Hx longer than 6mths or earlier if FSH or prolactin elevated
Mx
Weight loss induced
Normal FSH and LH present with oestrogen deficiency
Threshold weight of 47kg needed for menache and menstruation
Amenorrhoea can occur when 10kg of body weight is loss
Dietary supervision, increase calorie intake and regular weighing
Barrier method of contraception or progesteogen only pill
Polycystic ovaries
Obesioty, acne, hirsutism, infertility, amenorrhoea

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