Treatment of amenorrhoea
Treatment of primary amenorrhoea requires specialist referral. Treatment depends on the underlying cause; for some patients, it may be as for delayed puberty.
Treatment of secondary amenorrhoea also depends on the underlying cause. See advice on treatment of:
- eating disorders
- prolactinoma
- polycystic ovary syndrome
- hypothyroidism
- hyperthyroidism
Review any medications that may cause hypothalamic or pituitary suppression or hyperprolactinaemia. Use an alternative medication if possible.
Estrogen therapy often forms part of the treatment of amenorrhoea related to hypothalamic or pituitary disorders (including functional hypothalamic amenorrhoea). Estrogen is recommended for all individuals with premature ovarian insufficiency. Progestogen is also required for endometrial protection in individuals with endometrial tissue. A combined oral contraceptive (COC) or contraceptive vaginal ring are options if contraception is required, otherwise combined estrogen and progestogen menopausal hormone therapy (MHT) that contains a medium to high dose of estrogen can be used.
Use of COC, contraceptive vaginal ring or MHT may mask return of spontaneous ovulation. Ensure individuals taking MHT are aware of this and that MHT does not provide contraception.
Assess bone health with bone mineral density scanning in prolonged secondary amenorrhoea. Estrogen therapy (COC or MHT) partially addresses the effect of long-term estrogen deficiency on bone mineral density. In functional hypothalamic amenorrhoea, correction of energy imbalance with weight gain and improved nutrition is required to assist bone recovery.
Review modifiable cardiovascular risk factors in all individuals with secondary amenorrhoea. Increased cardiovascular risk is seen in individuals with premature ovarian insufficiency or early menopause, hypothalamic and pituitary causes of amenorrhoea and polycystic ovary syndrome. However, it is unclear if cardiovascular risk is increased in females with other causes of estrogen deficiency.