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