Amenorrhoea and infertility — DRCOG MCQ
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Correct answer: C — Serum prolactin and thyroid function tests
Galactorrhoea with absent periods and infertility points to hyperprolactinaemia. Raised prolactin suppresses pulsatile GnRH, causing hypogonadism, amenorrhoea/oligo-ovulation and infertility; therefore serum prolactin is the key first test. Thyroid function tests should be checked alongside it because primary hypothyroidism can increase TRH, stimulate prolactin release and cause the same menstrual and fertility features. Chlamydia/gonorrhoea NAAT assesses tubal/STI risk, not the endocrine syndrome here; trying for longer is inappropriate after 12 months with amenorrhoea/galactorrhoea; TFTs alone miss hyperprolactinaemia; and transvaginal ultrasound is not the first investigation for galactorrhoea-associated amenorrhoea.
Reference: NICE guideline NG257: Fertility problems: assessment and treatment, 2026 — https://www.nice.org.uk/guidance/ng257/chapter/Investigation-of-fertility-problems-and-management-strategies