Amenorrhoea is defined as the absence of menses in a female who has never menstruated (primary amenorrhoea) or the cessation of menses in a woman with previously normal menstrual cycles (secondary amenorrhoea). Excluding physiological causes, secondary amenorrhoea has a prevalence of 3–4% in the general population compared with 0.3% for primary amenorrhoea. Women with fertility problems and competitive athletes are particularly over-represented. The causes of amenorrhoea are numerous. Careful history taking and physical examination therefore informs further management and determines which patients warrant referral to secondary care. This article aims to address the differential diagnosis, assessment and investigation of amenorrhoea in primary care. Key management principles will also be discussed.
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