Amenorrhoea and oligomenorrhoea
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Amenorrhoea is the absence of menses. Based on the previous occurrence of menstruation, amenorrhoea is divided into primary and secondary. It is important to remember that amenorrhoea and oligomenorrhoea are symptoms and not a final diagnosis. The occurrence of regular menses requires a coordinated interaction between the hypothalamus, pituitary, ovaries and the outflow tract. A disturbance at any of these levels can lead to amenorrhoea. Exogenous recombinant leptin replacement has been shown to improve reproductive and neuroendocrine function in women with hypothalamic amenorrhoea. Clinical examination, particularly in cases of primary amenorrhoea, may reveal physical characteristics of Turner syndrome, outflow obstruction and allow for examination of secondary sexual character development. According to the findings, investigations may be required at this stage including karyotyping or gonadotrophin measurement. Amenorrhoea and oligomenorrhoea can arise from a disturbance at the level of any of the key structures controlling the menstrual cycle. Pregnancy should always be excluded in a patient presenting with secondary amenorrhoea.