Secondary amenorrhoea

Cessation of menstruation for 6 consecutive months in a woman who has previously had regular periods, is the usual criteria for investigation. However, some authorities consider 3 or 4 months amenorrhoea to be pathological but here we enter the grey area between amenorrhoea and oligomenorrhoea. Women with secondary amenorrhoea must have a patent lower genital tract, an endometrium that is responsive to ovarian hormone stimulation and ovaries that have responded to pituitary gonadotropins.

Secondary amenorrhoea is best classified according to its aetiological site of origin and can be subdivided into disorders of the hypothalamic-pituitary-ovarian-uterine axis and generalized systemic disease. The principal causes of secondary amenorrhoea are outlined in Table 39.5. The frequency with which these conditions present can be seen in Table 39.6.

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