Keywords: Oligomenorrhoea


Appropriate Tests


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.

Without androgen excess


Physiological, especially


  • Pregnancy

Beta HCG quantitation

  • Lactation


  • Menopause

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.

Post-oral contraceptive use

A brief period of amenorrhoea may occur.

Intensive exercise




Serious illness


Major weight loss, especially


  • Anorexia nervosa


  • Malnutrition


Endocrine disorders, especially


  • Hyperthyroidism
  • Hypothyroidism
  • Pituitary/hypothalamic disorders


  • Hyperprolactinaemia

See Pituitary hormone excess.

Chromosomal abnormalities especially

Cytogenetics - constitutional.

  • Turner syndrome

Cytogenetic studies

  • Gonadal agenesis


  • 17α-hydroxylase deficiency


  • Androgen resistance syndromes

Patients are phenotypically female but genotypically male, with male testosterone levels.

Cytogenetics - constitutional. Testosterone.

  • Complete testicular feminisation


  • Incomplete testicular feminisation


  • Steroid 5α-reductase 2 deficiency




Sex cord/stromal tumours especially

  • Granulosa-theca cell tumour


Anatomical abnormalities, especially

  • Post-traumatic uterine adhesions
  • Imperforate hymen
  • Vaginal atresia


Autoimmune ovarian failure

Ovarian Ab, if positive, further autoimmune endocrinopathies should be sought.

See Thyrogastric cluster.

Cytotoxic drugs/irradiation

Specific drug levels as appropriate.

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.

Polycystic ovary syndrome


Sex cord/stromal cell tumour especially

  • Sertoli/Leydig cell tumour
  • Hilar cell (lipoid) tumour


Cushing's syndrome


Congenital adrenal hyperplasia especially

  • 21-hydroxylase deficiency


For late onset patients the test may need to be done following Synacthen stimulation.

Drug-induced, especially

  • Anabolic steroids

Anabolic steroids urine.

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