Makindo Medical Notes

Related Subjects: |Male Infertility |Sheehan's syndrome

⚠️ Amenorrhoea: Absence of menstruation. Investigations depend on whether secondary sexual characteristics are present. 👉 If absent ➝ investigate at 16. If present ➝ investigation can wait until 18.

📌 Definitions

• 🟣 Primary Amenorrhoea: No menarche by age 16 (with secondary sexual characteristics) or by age 14 (without them).
• 🟠 Secondary Amenorrhoea: Absence of periods for >6 months in someone with previous normal cycles.

📊 Causes of Primary Amenorrhoea

📊 Causes of Secondary Amenorrhoea

🧪 Investigations (Stepwise Approach)

• 1️⃣ Pregnancy test – always first in secondary amenorrhoea.
• 2️⃣ Hormonal profile: FSH, LH, estradiol, prolactin, TSH, testosterone.
• 3️⃣ Imaging: Pelvic USS (uterus, ovaries, PCOS, Müllerian agenesis).
• 4️⃣ Special tests: Karyotyping (Turner’s, AIS, POI), MRI brain (Kallmann, prolactinoma).
• 5️⃣ Endocrine tests: Dexamethasone suppression test (Cushing’s), cortisol, TFTs.

💊 Management Principles

• 🎯 Treat the underlying cause (e.g. PCOS, Asherman’s).
• 💊 Replace hormones where needed (HRT in POI, Turner’s, Kallmann).
• 🧠 Provide psychological support (AIS, MRKH, infertility).
• 🦴 Optimise bone health (calcium, vitamin D, bisphosphonates if premature menopause).
• 👩‍👩‍👧 Involve MDT: endocrinology, gynaecology, psychology, fertility specialists.

📝 OSCE / Exam Pearls

• Always state: “First, exclude pregnancy.”
• Know the classic features of Turner’s, AIS, MRKH, and Kallmann’s.
• In secondary amenorrhoea, think: PCOS, hypothalamic stress, POI, Asherman’s.
• For POI ➝ HRT + bone protection + psychological support.
• For Asherman’s ➝ hysteroscopic adhesiolysis is gold standard.