Amenorrhoea, primary and secondary
Exclude pregnancy first, then use FSH, LH, oestradiol, prolactin and TSH to place the problem in the hypothalamus, pituitary, ovary or outflow tract. Hypothalamic amenorrhoea, PCOS, hyperprolactinaemia and premature ovarian insufficiency cause most secondary amenorrhoea; protect bone when oestrogen is low.
Tier 2Approach to a presentation
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Primary: no menarche by 15 with normal breast development, by 13 with none, or more than 3 years after thelarche.
- Secondary: no periods for 3 months after regular cycles or 6 months after irregular ones.
- Exclude pregnancy first. Then the hormone pattern tells you where the block is.
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Finished reading?
Sources
- Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril 2008;90(5 Suppl):S219-25American Society for Reproductive Medicine, 2008 (reaffirmed; no later ASRM version found, November 2026)
- Gordon CM, Ackerman KE, Berga SL et al. Functional hypothalamic amenorrhea: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2017;102:1413-39Endocrine Society, 2017 (still current, November 2026)
- Panay N, Anderson RA, Bennie A et al. Evidence-based guideline: premature ovarian insufficiency (ESHRE, ASRM, CRE, IMS). Hum Reprod Open 2024;hoae065European Society of Human Reproduction and Embryology, 2024
- Petersenn S, Fleseriu M, Casanueva FF et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international consensus statement. Nat Rev Endocrinol 2023;19:722-40Pituitary Society, 2023
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy