What lifestyle factors should I assess in patients with secondary amenorrhoea?

When assessing patients presenting with secondary amenorrhoea, it is important to evaluate the following lifestyle factors:

• Weight changes: Assess for recent weight loss or low body weight, as weight loss and low BMI can cause hypothalamic amenorrhoea. Encourage weight gain if underweight and consider referral to a dietician if necessary ¹,³.
• Exercise levels: Evaluate for excessive or high levels of exercise, which can contribute to exercise-related amenorrhoea. Advise reducing exercise and increasing calorie intake if appropriate ¹,³.
• Stress and psychological factors: Consider stress-related amenorrhoea and assess coping strategies. Management may include cognitive behavioural therapy to reduce stress ¹.
• Eating behaviours and disorders: Screen for eating disorders such as anorexia nervosa or bulimia, which can cause amenorrhoea. Prompt referral to specialist eating disorder services is recommended if suspected ¹,⁴.
• Nutrition and diet: Assess dietary intake to ensure adequate nutrition, calcium, and vitamin D, which are important for bone health and menstrual function ¹.
• Smoking and alcohol use: Evaluate smoking and excessive alcohol consumption, as these can negatively impact bone health and menstrual regularity ¹.

Addressing these lifestyle factors is essential for managing secondary amenorrhoea and preventing complications such as osteoporosis ¹.