ABSTRACT
The commonest pituitary cause of amenorrhoea is hyperprolactinaemia, which may be physiological due to lactation, or iatrogenic, or pathological. Treatment needs to be given to correct the amenorrhoea and oestrogen deficiency, improve libido and affect tumour shrinkage in cases with hyperprolactinaemia. The mechanism of action may be to destroy local tissue or disrupt dopamine production, resulting in hyperprolactinaemia. Treatment is usually surgical, and possibly radiotherapy. Primary amenorrhoea is the failure to menstruate by the age of 16 years, when the girl has developed normal secondary sexual characteristics, or failure to menstruate at the age of 14 years in the absence of any secondary sexual characteristics. Most cases of secondary amenorrhoea by definition would exclude congenital anomalies unless the individual had been using the oral contraceptive pill, which would induce a withdrawal bleed each month. Most causes of secondary amenorrhoea can cause amenorrhoea if the problem occurs before puberty.
