Gonadal system - amenorrhea, primary and secondary
Description
Definitions
- Primary amenorrhoea
- No menarche by 15y with normal secondary sexual characteristics, OR
- No menarche by 13y with no breast development, OR
- >3 years after thelarche
- Secondary amenorrhoea - cessation for >=3 months (regular cycles) or >=6 months (irregular cycles)
- Oligomenorrhoea - cycles >35 days or <9 cycles/year
The organising framework - four compartments
| Compartment | Example | FSH/LH | Oestradiol |
|---|---|---|---|
| I. Outflow tract / endometrium | Asherman, imperforate hymen, transverse septum, Mullerian agenesis | Normal | Normal |
| II. Ovary | Turner, POI, chemotherapy | HIGH | Low |
| III. Pituitary | Prolactinoma, Sheehan, hypophysitis | Low/normal | Low |
| IV. Hypothalamus | Functional hypothalamic amenorrhoea, Kallmann | Low | Low |
- *Always exclude pregnancy first. Then measure prolactin and TSH. Then split by FSH.*
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