A full medical history, clinical examination and appropriate investigations are organised with particular reference to the possible causes of amenorrhoea (Table 6.1). A family history of premature menopause or autoimmune disease (Q12.17) may focus attention on these areas. Your doctor will wish to know whether there is an associated infertility problem or need for contraception as this will influence management.

 

Table 6. 1 Some of the more frequent causes of amenorrhoea:

System or organ

Pathology

Question

Number

Physiological (natural)

(Pre-puberty, pregnancy, lactation and menopause

6.1

Generalised ill health

Stress

6.8

Weight loss e.g. anorexia

6.8

Diabetes

7.3

Thyroid disease

24.9

T.B.

20.12

Pituitary / Hypothalamus

Hyperprolactinaemia

6.10

Gonads (usually ovaries)

Polycystic Ovary Syndrome

7.2

Hormone secreting tumours

8.9

Turner's Syndrome

6.13

Testicular Feminisation

6.14

Resistant Ovary Syndrome

6.15

BSO (Removal of both ovaries)

24.23

Uterus

Congenital Absence

3.3

Hysterectomy

24.22

Asherman's Syndrome

6.18

Vagina

Imperforate Hymen

6.4

Congenital Absence

3.3

 

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