35.     Secondary amenorrhoea may be due to.

    (See also MCQ1, question 18 & MCQ2, question 11.)

Stress is always quoted as a cause of secondary amenorrhoea, but is one of the less common causes in practice.

More common nowadays are weight loss and excessive exercise.

Treatment will depend on the underlying cause and may vary from doing nothing to removing a hormone secreting ovarian tumour.

Cervical stenosis may occur after cone biopsy or Manchester Repair.

There is usually a history of cyclical pre-menstrual symptoms and dysmenorrhoea and haematometra can usually be seen on scan.

Ascherman's syndrome is intra-uterine adhesions due to over-curettage, particularly in association with a recently pregnant uterus.

LH-RH analogues interfere with the stimulation of the pituitary by the hypothalamus and "down-regulate" the pituitary.

This switches off the ovaries and induces a pseudo-menopause (see also MCQ 4, question 13).

If given in micro-dose at ninety minute intervals, the analogue mimics natural Gn-RH release and stimulates pituitary and ovarian activity.