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Initial clinical assessment including whether amenorrhoea is primary or secondary, although many of these disorders may present as either.
Some disorders may be associated with oligomenorrhoea rather than amenorrhoea.
Luteinising hormone. Follicle stimulating hormone. Oestradiol. Prolactin.
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Without androgen excess
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Physiological, especially
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Beta HCG quantitation
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The menopause is defined by amenorrhoea of >1 year duration, in a non-pregnant woman >35 years of age, usually associated with oestrogen deficiency symptoms. A perimenopausal transition period with fluctuating ovarian function may be present over several years. Luteinising hormone, Follicle stimulating hormone levels are increased, but the assays are only indicated if clinical doubt exists.
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Post-oral contraceptive use
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A brief period of amenorrhoea may occur.
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Intensive exercise
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Psychological/stress
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Serious illness
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Major weight loss, especially
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Endocrine disorders, especially
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Hyperthyroidism
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Hypothyroidism
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Pituitary/hypothalamic disorders
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See Pituitary hormone excess.
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Chromosomal abnormalities especially
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Cytogenetics - constitutional.
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Cytogenetic studies
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17α-hydroxylase deficiency
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Cortisol.
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Androgen resistance syndromes
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Patients are phenotypically female but genotypically male, with male testosterone levels.
Cytogenetics - constitutional. Testosterone.
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Complete testicular feminisation
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Incomplete testicular feminisation
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Steroid 5α-reductase 2 deficiency
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Sex cord/stromal tumours especially
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Granulosa-theca cell tumour
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Anatomical abnormalities, especially
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Post-traumatic uterine adhesions
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Imperforate hymen
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Vaginal atresia
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Autoimmune ovarian failure |
Ovarian Ab, if positive, further autoimmune endocrinopathies should be sought.
See Thyrogastric cluster.
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Cytotoxic drugs/irradiation
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Specific drug levels as appropriate.
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With androgen excess |
Testosterone, DHEA sulphate, Androstenedione, Luteinising hormone, Follicle stimulating hormone.
Hormone assays are not indicated if it is suspected that androgen excess is due to clandestine anabolic steroid use: see below.
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Polycystic ovary syndrome
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Sex cord/stromal cell tumour especially
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Sertoli/Leydig cell tumour
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Hilar cell (lipoid) tumour
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Cushing's syndrome
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Congenital adrenal hyperplasia especially
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21-hydroxylase deficiency
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17-hydroxyprogesterone.
For late onset patients the test may need to be done following Synacthen stimulation.
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Drug-induced, especially
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Anabolic steroids urine.
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