Secondary amenorrhoea

Definition/Description

When menstruation has occurred but has stopped for 6 consecutive months

Red Flag Symptoms

None provided

Guidelines on Management

Causes and investigations

  • Pregnancy- urinary or serum BHCG
  • Lactation
  • PCOS- LH/FSH/free androgen index/prolactin/TSH- see other guideline
  • Menopause inc premature ovarian failure ie menopause 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/metoclopromide/ tri-cyclics
  • Cushing’s /adrenal or ovarian carcinoma 
  • Congenital hyperplasia- testosterone > 5- also consider an androgen secreting tumour if levels are this high

Referral Criteria/Information

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
     

Investigations prior to referral

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

Associated Policies

There are no associated policies.

Specialties

Gynaecology York

Places covered by

  • vale-of-york

Hospital Trusts

  • york-and-scarborough-teaching-hospitals
Author:
Date created: 13/08/2025, 13:39
Last modified: 13/08/2025, 13:40
Date of review: 30.09.24