• Primary amenorrhoea

• Secondary amenorrhoea

• Ovarian/Metabolic 40%

• Hypothalamic 35%

• Uterine

• Other 1%

• LH, FSH

• Oestradiol

• Progesterone

• Prolactin

• High FSH, LH and low oestrogen

• 45XO Turner Syndrome, incl mosaic

• Partial X chromosome deletions

• FMR1gene, Fragile X syndrome

HA and OD HA and PCOM OD and PCOM HA, OD and PCOM

Ovulatory dysfunctionand PCOM

Hyperandrogenism,OD and PCOM

4%3.5%

45.8%

46.7%

Genes for insulin

secretion & action

Genes for

folliculogenesis

Genes for androgen

secretion & action

obesity

anovulation hyperandrogenism

insulin Polycystic

ovaries

Environmentespecially nutritional factors

Genetic factorsfamily history (50%)multiple genes

• Heritability

• Mothers

• Fathers

• Children

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Low / normal LH and FSH, low oestrogen

• Diagnosis

• Exercise

• Eating disorders

• Psychogenic

• Severe or prolonged illness

• Prognosis

Hyperprolactinaemia

• Causes

• Drugs

• Tumour

• Trauma• Infiltrative

• Iatrogenic

• Pituitary infarct or apoplexy