Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For a patient presenting with secondary amenorrhoea, the key hormonal tests to perform include:
- Pregnancy test: Pregnancy is a common cause of secondary amenorrhoea and should be excluded NICE CKS.
- Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH): Persistently elevated FSH and LH levels suggest premature ovarian insufficiency in women younger than 40 years of age NICE CKS. For diagnosing premature ovarian insufficiency, elevated FSH levels on two blood samples taken 4 to 6 weeks apart are used NICE NG23. Low FSH and LH levels may indicate hypopituitarism or a pituitary tumour NICE CKS. These gonadotrophins should also be measured in women with irregular menstrual cycles NICE CG156.
- Prolactin: This test should be offered to women who have an ovulatory disorder, galactorrhoea, or a pituitary tumour NICE CG156. Hyperprolactinaemia is a reason for referral to an endocrinologist NICE CKS.
- Testosterone: An increased testosterone level that is not explained by polycystic ovary syndrome (PCOS) may suggest an androgen-secreting tumour, late-onset congenital adrenal hyperplasia, or Cushing's syndrome NICE CKS.
- Thyroid Function Tests: Hypothyroidism is a recognised cause of secondary amenorrhoea NICE CKS. However, routine measurement of thyroid function should be confined to women with symptoms of thyroid disease NICE CG156.
- Progesterone: For women with prolonged irregular menstrual cycles, a blood test to measure serum progesterone in the mid-luteal phase of their cycle can be offered to confirm ovulation NICE CG156. Depending on the timing of menstrual periods, this test may need to be conducted later in the cycle and repeated weekly thereafter until the next menstrual cycle starts NICE CG156.