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Introduction to causes and management of amenorrhoea

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The occurrence of regular monthly periods in women of reproductive age is the most obvious manifestation of cyclical ovarian activity and it is only over the last century, as family size has declined, that women have experienced monthly periods for a substantial part of their lives.

Amenorrhoea is a physiological process that can occur in childhood, during pregnancy, during lactation and after the menopause.

All the physiological causes of amenorrhoea have pathological equivalents and, indeed, amenorrhoea may be the presenting symptom of underlying disease.

Primary amenorrhoea refers to a failure of menstruation by the age of 16 years in the presence of normal secondary sexual characteristics, or 14 years in the absence of other evidence of puberty. Secondary amenorrhoea is defined as absent periods for at least six months in a woman who has previously had regular periods, or 12 months if she has previously had oligomenorrhoea (bleeds less frequently than six-weekly).

Learning objectives

When you have completed this tutorial you should be able to:

  • adopt a systematic approach to the investigation and diagnosis of a complaint of amenorrhoea
  • initiate management of common problems
  • select appropriate patients for referral to tertiary care or allied specialties
  • appreciate that adolescent gynaecology patients benefit from specifically tailored care.

Last updated: 28/06/10 (tutorial was reviewed and updated by Jude Ifionu, who added 11 pages of final assessments)

22/01/10 (image of a GnRH pump replaced with a new, higher quality image)

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