Last updated: Wednesday, 27, October, 2010
Initial clinical assessment including whether amenorrhoea is primary or secondary, although many of these disorders may present as either.
Some disorders may be associated with oligomenorrhoea rather than amenorrhoea.
Without androgen excess
The menopause is defined by amenorrhoea of >1 year duration, in a non-pregnant woman >35 years of age, usually associated with oestrogen deficiency symptoms. A perimenopausal transition period with fluctuating ovarian function may be present over several years. LH, FSH levels are increased, but the assays are only indicated if clinical doubt exists.
Post-oral contraceptive use
A brief period of amenorrhoea may occur.
Major weight loss, especially
Endocrine disorders, especially
|See pituitary hormone excess|
Chromosomal abnormalities especially
Cortisol - plasma.
Patients are phenotypically female but genotypically male, with male testosterone levels.
Cytogenetics (constitutional), Testosterone.
Sex cord/stromal tumours especially
Anatomical abnormalities, especially
Autoimmune ovarian failure
Ovarian antibodies: if positive, further autoimmune endocrinopathies should be sought.
See Thyrogastric cluster.
With androgen excess
Testosterone, Dehydroepiandrosterone sulphate, Androstenedione, LH, FSH.
Hormone assays are not indicated if it is suspected that androgen excess is due to clandestine anabolic steroid use: see below.
Sex cord/stromal cell tumour especially
Congenital adrenal hyperplasia especially
For late onset patients the test may need to be done following Synacthen stimulation.
Anabolic steroids - urine.