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Secondary Amenorrhoea (missed periods) – Information for GPs

Definition

When menstruation has occurred but has stopped for 6 consecutive months

Management (causes and investigations)

Pregnancy – urinary or serum BHCG

Lactation

PCOS – LH/FSH/free androgen index/prolactin/TSH – see other RSS guideline

Menopause – inc premature ovarian failure is menopause <40yrs – raised FSH

Contraception – depo/implant/POP/Mirena/post pill amenorrhoea

Weight loss – especially if rapid and BMI <19 and >10% of body weight has been lost – low FSH and LH

Cervical Stenosis/intra uterine adhesions – USS

Sheehan’s syndrome – low prolactin

Pituitary tumour – prolactin often in the thousands

Drugs – causing raised prolactin inc heroin / phenothiazines / metociopromide / tri-cyclics

Cushing’s adrenal or ovarian carcinoma

Congenital hyperplasia – testosterone >5 – also consider an androgen secreting tumour if levels are this high

Investigations prior to referral

  • Exclude pregnancy
  • Blood tests – FSH/LH/free androgen index/TFT/prolactin
  • Consider USS

Information to include in referral letter

  • LMP and previous cycle
  • Recent weight loss / gain
  • Contraception used
  • Any symptoms e.g. sweats, hair growth
  • Smear history
  • Relevant past medical / surgical history
  • Current regular medication
  • BMI
  • Smoking status
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