Secondary amenorrhoea – a management problem

Linda Goss
Department of Endocrinology, Royal Devon and Exeter Hospital, Exeter, UK

Endocrine Nurses Training Course 2005, John MacIntyre Centre, The University of Edinburgh, 18 Holyrood Park Road, Edinburgh EH16 5AY, UK
30 August - 1 September 2005

A 24 year old presented to the endocrine service in 2003 with secondary amenorrhoea. She started her periods at the age of 12 but these continued to be irregular. She commenced the oral contraceptive pill at the age of 20.

She had stopped the oral contraceptive pill 18 months before due to breast tenderness and had not had any periods since. Her BMI was normal however she did have a history of exercising heavily and weight loss. She had lost 10kgs in weight over the previous 8 – 10 years. There was no family history of endocrine disorders.

Initial biochemistry confirmed a low oestradiol of <37 pmol/L with low / normal gonadotrophins – FSH 4.7 iu/L and LH 0.3 iu/L. Liver and renal function tests were normal as were thyroid function tests, Prolactin, HCG, testosterone and a short synacthen test. An MRI scan was performed which showed no abnormality of the pituitary gland. An LHRH test was also performed with a normal response.

Due to low oestradiol levels Joanne is at risk of osteoporosis and is now requesting fertility.

I am presenting this case as I believe it raises some interesting issues about future management.

Revised: 16-Sep-2005