Secondary Amenorrhoea

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1 Background Information / Scope of Pathway

These pathways were developed to guide clinicians when managing secondary Amnorrhoea
The pathways are not provider specific and so the guidance and forms apply to all providers.

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2 Information Resources for Patients and Carers

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3 Development and Updates to this Pathway

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4 Referral Forms

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10 Examination

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Weight/Height/BMI,
General inspection- hirsuitism, acne, secondary sexual characteristics, galactorroea,
Abdominal and pelvic exam

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11. Investigations: Dependent on history

Pregnancy test
LH/Fsh/Oestradiol (PCOS, Ovarian, hypothalamic causes)
Prolactin (pituitary, drug causes)
Testosterone (PCOS, Late onset CAH, tumour)
TFTs (hypothyroidism)

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12. Issues to consider;

Fertility
Bone protection DEXA - If the cause of secondary amenorrhoea is associated with oestrogen deficiency, after one year of amenorrhoea an assessment of bone density is advised
Endometrial protection (coc or quarterly progesterone challenge to induce withdrawal bleed)
Lifestyle advice
Treatment of underlying cause as required- stopping drugs, treating hypothyroidism
Referral on if rare cause found or if requires behavioural help for anorexia. 

In certain circumstances consider;
SHBG (raised in COC use therefore free testosterone decreased, or suppressed by insulin resistance and obesity therefore free testosterone increased)
17 alpha hydroxyprogesterone (raised in late onset CAH)
USS pelvis (PCOS, Adrenal/Ovarian mass)
Karyotyping for Turners etc. if premature ovarian failure under age 30
Consider CT/MRI head