How do I identify the underlying cause of secondary amenorrhoea?
• Exclude pregnancy and other physiological causes, such as lactation or menopause (in women 40 years of age or older). • Elicit the woman’s concerns (for example about infertility — see the CKS topic on Infertility). • Enquire about: • History of infertility. • History of contraceptive use. • Hot flushes and vaginal dryness (suggesting premature ovarian failure). • Headache, visual disturbances, or galactorrhoea (for a pituitary tumour). • Acne and hirsutism. • Weight loss or gain (for eating disorders and polycystic ovary syndrome). • Stress or depression (for stress-related hypothalamic amenorrhoea). • Exercise level (for exercise-associated hypothalamic amenorrhoea). • Symptoms of thyroid and other endocrine disease. • Menstrual, obstetric, and surgical history (such as endometrial curettage, which may suggest intrauterine adhesions — Asherman’s syndrome). • Medical history, including: chemotherapy; pelvic radiotherapy (which can cause premature ovarian failure); and cranial radiot
