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afya Amenorrhoea

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20160425222536 Ben  
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divide into primary (no menses by 16y) or secondary (cessation of established, regular menstruation for 6/12+)

''Causes of primary amenorrhoea''
    Turner's syndrome
    testicular feminisation
    congenital adrenal hyperplasia
    congenital malformations of the genital tract

''Causes of secondary amenorrhoea (after excluding pregnancy)''
    hypothalamic amenorrhoea (e.g. Stress, excessive exercise)
    polycystic ovarian syndrome (PCOS)
    hyperprolactinaemia
    premature ovarian failure
    thyrotoxicosis (or hypothyroid)

''Initial investigations''
    exclude pregnancy with urinary or serum bHCG
    gonadotrophins - (low - hypothalamic, high - ovarian eg POF)
    prolactin
    androgen levels - eg PCOS
    oestradiol (progesterone doesn't help)
    thyroid function tests