Current investigation and therapy of secondary amenorrhoea

The advent of radioimmunoassays enabling measurement of pituitary gonadotrophins, ovarian and adrenal steroids and prolactin has allowed precise investigation of patients with secondary amenorrhoea. The most frequently encountered causes of this disorder are associated with hypothalamic-pituitary failure or dysfunction. Clinical and radiographic investigations must be utilised to look for the presence of a pituitary fossa space occupying lesions, particularly when hyperprolactinaemia is found. The presence of hirsutism should alert to the possibility of an adrenal or ovarian tumour or more commonly the presence of the polycystic ovary syndrome. When fertility is required, recommencement of menstrual cycles will often be possible with ovulation-inducing drugs. Patients not wishing to be fertile will often require oestrogen therapy while amenorrhoea persists, as low endogenous oestrogen levels may otherwise lead to menopausal degenerative changes.