Amenorrhoea

Definition

• Primary amenorrhoea: no menarche by 15 yrs, earlier if no puberty.
• Secondary amenorrhoea: menses cessation >3 months with prior cycles.
• Oligomenorrhoea: cycle intervals of more than 38 days.
• The first thought in any case of secondary amenorrhoea: pregnancy (pregnancy test).

Classification

Special forms

• Asherman's syndrome: intrauterine synechiae after procedures/infections.
• Its clinical presentation: hypo-/amenorrhoea, infertility, miscarriages.
• Sheehan's syndrome: anterior pituitary necrosis after postpartum haemorrhage.
• Its first sign in the puerperium: failed lactation, fatigue, hypotension.
• In primary amenorrhoea with absent puberty: karyotyping (e.g., Turner syndrome).

Diagnosis

Stepwise work-up

• Basic labs: TSH, prolactin, FSH, LH, oestradiol, testo, DHEAS.
• What high FSH with low oestradiol indicates: primary ovarian cause.
• What low FSH with low oestradiol indicates: hypothalamic-pituitary cause.
• Most common hypothalamic cause in a young woman: functional amenorrhoea (weight, sports, stress).
• If a uterine cause is suspected: ultrasound and hysteroscopy.

Progestogen Challenge Test and What It Shows

• No bleeding: oestrogen deficiency or uterine cause.
• Next step then: oestrogen-progestogen test.

Keep learning in the app

Further reading (selection)

1. StatPearls: Amenorrhea (NCBI Bookshelf)
2. StatPearls: Primary Amenorrhea (NCBI Bookshelf)
3. DocCheck Flexikon, Amenorrhoe

Cross-references