Worrying wait

Mandy is a 28-year-old finance manager who presents to her GP with a six-month history of amenorrhoea. She does not smoke and drinks alcohol socially.

There is no relevant family history. She went through menarche at the age of 12 and had regular periods up until six months ago. She reports no visual disturbances and no galactorrhoea. She has had episodic transient headaches.

On examination, Mandy weighs 57.3kg. Her blood pressure is 110/70mmHg with a heart rate of 80bpm. She has normal visual fields with normal eye movements. The remainder of her examination is unremarkable.

Secondary amenorrhoea (absence of periods for more than six months or three cycles) can be due to dysfunction of the pituitary, ovaries, uterus or hypothalamus.

Initial evaluation should include a complete history and examination. In women with amenorrhoea, or oligomenorrhoea