Primary amenorrhoea: no menstruation by 14 years of age in the absence of secondary sexual characteristics; or failure to menstruate by 16 years of age. Secondary amenorrhoea: amenorrhoea for at least 3 months in women with previous normal menses
» Body mass index.
» Urine pregnancy test.
» Pelvic ultrasound.
» Serum for TSH, FSH, LH, prolactin.
FSH > 15 units/L in a young woman (< 40 years) suggests premature ovarian failure.
LH/FSH ratio of > 2:1 suggests polycystic ovarian syndrome.
For treatment of hyperprolactinaemia, hypo- or hyperthyroidism, see Chapter 8: Endocrine System.
If no cause for secondary amenorrhoea is found:
- Medroxyprogesterone acetate, oral, 10 mg daily for 10 days.
o Anticipate a withdrawal bleed 5–7 days following conclusion of treatment.
» All cases of primary amenorrhoea.
» Secondary amenorrhoea not responding to medroxyprogesterone acetate.
» Polycystic ovarian syndrome and premature ovarian failure, for further evaluation.