Introduction
WIPER
Presenting Complaint
Past Medical History
Medications
Family History
Social History
Differential Diagnosis
When taking a history from a patient with amenorrhoea or oligomenorrhoea, it is important to approach the conversation with empathy and clarity. Begin by clarifying the nature and timing of menstrual changes—whether periods have stopped completely or become infrequent—and establish the duration of the problem. Ask about age at menarche, previous cycle regularity, and any associated symptoms such as weight changes, stress, hirsutism, acne, or galactorrhoea. Inquire about lifestyle factors like exercise, diet, and psychological stress, as well as sexual activity, contraception, and the possibility of pregnancy. A thorough medical, surgical, and family history can also provide important clues. Ensure the patient feels supported and that the discussion remains respectful and private.
Introduction: Introduce yourself by your full name and your role
Patient details: Gather the patient’s full name and DOB
Explain/Establish: Explain what you are going to do and Establish consent
ExPose: Expose & Position the patient if necessary.
History of presenting complaint:
Menstrual HistoryOnset - How long has this been going on for?LMPPrimary or secondary amenorrhoea - Did you have normal periods before?Duration of periodAge at menarche
Onset - How long has this been going on for?
Primary or secondary amenorrhoea - Did you have normal periods before?
Thyroid dysfunction - temperature intolerance, hair thinning, weight gain.
PCOS symptomsAcne or hirsutism?Weight gain?
Lifestyle: How often do you exercise?
HyperprolactinaemiaAny discharge from your nipples?Any headache or visual disturbances?
Any discharge from your nipples?
Any headache or visual disturbances?
OTC, herbal or prescribed medications
Any current or recent history of contraception use?
Do any conditions run in your family?
Ask specifically about autoimmune disease and thyroid disease
Smoking, alcohol, drink, occupation, hobbies
Separate differentials into most likely, less likely and can’t miss. Each section will differ based on results from the history and examination
Amenorrhoea can either be primary (menses not started by age of 16 years) or secondary (previously normal menses ceased for at least 6 months).
Not reached menarche by age 16 years
Most commonly constitutional delay; less commonly due to Turner’s syndrome, testicular feminisation or polycystic ovarian syndrome
In constitutional delay, the patient’s mothers and sisters may also have been late in starting.
Drug-induced e.g. hormonal contraception. Can take up to a year for effects to reverse.
Hypogonadotropic hypogonadism - low FSH and LH.
Remember: Bedside --> Laboratory --> Imaging
Bedside examination includes:
Bimanual +/- speculum examination
Laboratory investigations include bloods such as:
Bloods - FSH, LH, oestrogen, TFTs and prolactin
Ultrasound eg: TVUS, Abdominal ---- PCOS
MRI head to assess for pituitary or hypothalamic causes
Tailor the management based on diagnoses
Discuss with all relevant persons ie: the patient and colleagues