Consider the hypothalamic-pituitary-ovarian axis + possible outflow obstruction. Too little or no FSH? Too high oestrogen? Too little or no estrogen? Outflow tract obstruction? Also think congenital vs acquired?
(Note: All conditions that can cause secondary amenorrhoea can also cause primary amenorrhoea. However there are some distinctive causes of primary amenorrhoea)
Primary amenorrhoea - check height
Short:
1. Growth hormone deficiency
2. Thyroid hormone deficiency
3. Genetic problems (eg Turner's)
Normal height / Tall:
1. Gonadotropin-deficient either from hypothalamus or pituitary problems
2. Endocrine disorder
3. Premature menopause
4. Congenital absence of uterus / ovaries5. Outflow obstruction
6. Causes of secondary amenorrhoea (see below especially if normal breast development and uterus intact
Secondary amenorrhoea
1. PCOS especially if normal FSH, normal or slightly elevated LH, high androgen levels, obesity, diabetic
2. Hyperprolactaemia
3. Polyglandular auto-antibodies
4. Outflow tract obstruction especially if Hx of prev surgery / instrumentation
(Note: All conditions that can cause secondary amenorrhoea can also cause primary amenorrhoea. However there are some distinctive causes of primary amenorrhoea)
Primary amenorrhoea - check height
Short:
1. Growth hormone deficiency
2. Thyroid hormone deficiency
3. Genetic problems (eg Turner's)
Normal height / Tall:
1. Gonadotropin-deficient either from hypothalamus or pituitary problems
2. Endocrine disorder
3. Premature menopause
4. Congenital absence of uterus / ovaries5. Outflow obstruction
6. Causes of secondary amenorrhoea (see below especially if normal breast development and uterus intact
Secondary amenorrhoea
1. PCOS especially if normal FSH, normal or slightly elevated LH, high androgen levels, obesity, diabetic
2. Hyperprolactaemia
3. Polyglandular auto-antibodies
4. Outflow tract obstruction especially if Hx of prev surgery / instrumentation