What lifestyle factors should I assess in patients with secondary amen

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

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 ,.
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 ,.
Stress and psychological factors: Consider stress-related amenorrhoea and assess coping strategies. Management may include cognitive behavioural therapy to reduce stress .
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 ,.
Nutrition and diet: Assess dietary intake to ensure adequate nutrition, calcium, and vitamin D, which are important for bone health and menstrual function .
Smoking and alcohol use: Evaluate smoking and excessive alcohol consumption, as these can negatively impact bone health and menstrual regularity .

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

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