Most cases of amenorrhoea can be evaluated by taking a careful history, performing a physical examination and measuring hormone levels. Initial investigations for primary and secondary amenorrhoea are similar, although primary amenorrhoea should prompt an earlier pelvic ultrasound and karyotyping.
- Polycystic ovary syndrome, functional hypothalamic amenorrhoea, hyperprolactinaemia and primary ovarian insufficiency are the most common causes of amenorrhoea.
- Initial investigations should include measurement of beta-human chorionic gonadotropin, thyroid stimulating hormone, follicle stimulating hormone and prolactin levels, and androgen levels if suggestive from the history.
- Pregnancy should always be ruled out in women presenting with amenorrhoea.
- Women should be asked about their menses at routine clinic appointments.