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Feature Article

Amenorrhoea: a guide for GPs

Clare Boothroyd

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Abstract

Most women with amenorrhoea can be evaluated and managed in general practice, without the need for specialist referral.

Key Points

  • Always consider pregnancy when investigating amenorrhoea.
  • Hormonal contraception can be associated with amenorrhoea. Simple reassurance is generally the only management required.
  • Polycystic ovarian syndrome may be associated with endometrial hyperplasia and a small risk of carcinoma when severe oligomenorrhoea or amenorrhoea supervenes. Treatment with combined oral contraceptives or cyclic progestins reduces this risk. Endometrial sampling may be required.
  • Polycystic ovarian syndrome is associated with insulin resistance and an increased risk of diabetes mellitus.
  • Hypo-oestrogenic states have an associated risk of osteopenia and osteoporosis. Bone mineral density testing is required.

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