INVESTIGATIONS, TREATMENT PLAN, KEY INFORMATION & EXTRA’S
INVESTIGATIONS
- PV examination for adults, not for children (can do USS)
- Blood tests o Prolactin levels:
- >1000: Refer urgently to the endocrine team, MRI needed.
- Most have a mild increase secondary to stress/medications like antipsychotics (risperidone), SSRI, antiemetics (metoclopramide or domperidone)
- FSH and LH (if no secondary sexual characteristics and normal FSH/LH, then do Karyotyping)
- If normal: outflow obstruction, functional hypothalamic amenorrhoea, PCOS
- High levels: if short then think of Turner’s, if normal height, think of primary ovarian failure
- Low levels: if short, then think of hydrocephalus, if normal height, think of constitutional delay/weight loss/excessive exercise/anorexia
- Testosterone:
- Mild increase: PCOS.
- High levels: androgens in humour/CAH/androgen insensitivity o Other investigations: oestradiol, TSH
- Ultrasound: pelvic o Uterus present (presence of secondary sexual characteristics: outflow obstruction/PCOS)
- Uterus present (absence of secondary sexual characteristics: Turner’s syndrome/gonodal Agenesis)
- Uterus absent (androgen insensitivity syndrome)
- Karyotyping: if no secondary sexual characteristics with normal FSH/LH
TREATMENT PLAN
- Refer to gynaecology: For most primary & secondary amenorrhea cases
- Refer to endocrinology: hormonal issues (androgen, thyroid, prolactin, testosterone, Cushing’s)
- Primary care management: PCOS, hypothyroidism, menopause, pregnancy
KEY INFORMATION
- Differentiate between primary and secondary amenorrhea
- Consider anatomical, hormonal, and functional causes
- Investigate with blood tests and imaging
- Refer complex cases to specialists
EXTRA’S
- Complications: osteoporosis, fractures, CVD, infertility, psychological stress.