Oligomenorrhoea:
“ the occurrence of menses on only five or fewer occasions per year”
2ry Amenorrhoea:
“ the absence of menses for 6 months ( or greater than three times the previous cycle intervals) in a woman who has menstruated before”
Rule out PREGNANCY

Hypo-estrogenic 2ry Am’rrhoea
Hypothalamic-pituitary dysfunction
Premature ovarian failure
Hyperprolctinemia

Hypothalamic-pituitary dysfunction:
Eating disorders e.g, Anorexia nervosa, extensive dieting or exercise. A loss of >10 kg … a’hoea… estrogen lllow …osteoporosis
Hypothalamic lesions
Nonsecreting pituitary adenomas
Other CNS system neoplasms
Sheehan’s syndrome

Premature ovarian failure:
Causes:
Chromosomal abnormalities. Amenorrhoea < 35 years of age
47 XXY ….. High risk of malignancy… gonadectomy
Turner’s syndrome mosaic (XX/XO)

Resistant ovarian syndrome. May be due to auto antibodies against ovaries or gonadotropin receptors. Could be part of disease involving thyroid, adrenal and acid receptors in stomach
If  present in younger age <35 years check auto antibodies

Premature menopause. < 45 mainly familial
High FSH & LH Low Estradiol, chromosomal analysis / ovarian biopsy

Hyperprolactinemia
Causes
Prolactin secreting tumours. 40-50% of cases; most are “micro-adenomas” (,10mm diameter). Macro adenoma levels >2500-3000 mU/l
Idiopathic. 40% levels are usually <2500 mIU/L
Other tumours compressing the the pituitary stalk. Rare, e.g. cranio- pahryngioma.
Primary hypothyroidism (3-5%).
Drugs (1-2%).  Metochlopramide and phenothiazides are the commonest + cimetidine, haloperidol, methyl dopa and reserpine
Systemic problems.
Acromegaly
Acute or chronic renal failure
Herpes zoster of the breast dermatomes

Investigation
Slight to moderate elevation. Repeat the test, if still high, screen for gross abnormality by lateral skull X-ray. If it shows enlargement of the pituitary fossa or erosion of the clinoid process …. CT scan to detect macro-adenoma.
Marked elevation… repeat the test + arrange CT scan ASAP. Specially urgent when headache or visual field defect present

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