### Key messages Evelyn, a 20-year-old student, attends her university general practitioner (GP) practice for the first time with a history of her periods becoming further apart and then stopping. Her periods had been regular previously, when living at home, but they have become more irregular in the last 12 months. Her body mass index (BMI) is 19 kg/m2 (weight 45 kg, height 1.53 m). Although definitions vary, secondary amenorrhoea should be suspected if a woman has not had a period for 3–6 months with previous regular periods or 6–12 months in a woman with preceding oligomenorrhoea. Secondary amenorrhoea has a prevalence of 3%–4% in women of reproductive age1 and can present a diagnostic challenge, with a wide range of underlying causes, often with minimal or subtle signs (figure 1). In the context of a normal puberty, the most common causes in this age group are pregnancy, hypothalamic dysfunction, polycystic ovary syndrome (PCOS), hyperprolactinaemia and drugs (including hormonal contraception and recreational drugs). Figure 1 Causes of secondary amenorrhoea. A detailed menstrual history, from menarche to the last menstrual period, is required to verify secondary amenorrhoea and elicit relevant timescales and any associated factors. A sexual and contraceptive history should then be used to assess pregnancy risk and exclude causes related to hormonal contraception. In this case, Evelyn reports “about ten” casual partners during her current university …

中文翻译：

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次要闭经-咨询。

###关键信息伊芙琳（Evelyn）是一名20岁的学生，她第一次参加大学的全科医生（GP）实习，因为她的病史逐渐分开，然后停下脚步。以前，她在家期间的生活是正常的，但是在过去的12个月中，情况变得更加不规律。她的体重指数（BMI）为19千克/平方米（体重45千克，身高1.53 m）。尽管定义不尽相同，但如果女性没有以前定期的3–6个月或之前患有少经的女性6–12个月，则应该怀疑继发性闭经。在育龄妇女中，继发性闭经的患病率为3％–4％1，并且可以提出诊断挑战，其潜在原因范围广泛，通常征兆很少或较细微（图1）。在青春期正常的情况下，此年龄组中最常见的原因是怀孕，下丘脑功能障碍，多囊卵巢综合症（PCOS），泌乳激素过多症和药物（包括激素避孕药和休闲药）。图1继发性闭经的原因。需要详细的月经史，从初潮到最后一个月经，以验证继发性闭经并得出相关的时间尺度和任何相关因素。然后应使用性和避孕史来评估怀孕风险，并排除与激素避孕有关的原因。在这种情况下，伊夫琳（Evelyn）报告说，在她目前的大学中，“大约有十个”休闲伴侣…… 图1继发性闭经的原因。需要详细的月经史，从初潮到最后一个月经，以验证继发性闭经并得出相关的时间尺度和任何相关因素。然后应使用性和避孕史来评估怀孕风险，并排除与激素避孕有关的原因。在这种情况下，伊夫琳（Evelyn）报告说，在她目前的大学中，“大约有十个”休闲伴侣…… 图1继发性闭经的原因。需要详细的月经史，从初潮到最后一个月经，以验证继发性闭经并得出相关的时间尺度和任何相关因素。然后应使用性和避孕史来评估怀孕风险，并排除与激素避孕有关的原因。在这种情况下，伊夫琳（Evelyn）报告说，在她目前的大学中，“大约有十个”休闲伴侣……