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  1. Georgina Louise Jones, non-clinical senior lecturer1,
  2. William Ledger, head of academic unit of reproductive and developmental medicine2,
  3. Caroline Mitchell, general practitioner and clinical senior lecturer3
  1. 1Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA
  2. 2University of Sheffield, Jessop Wing Hospital, Sheffield S10 2JT
  3. 3Division of Primary Medical Care, University of Sheffield, Northern General Hospital, Sheffield S5 7AU
  1. Correspondence to: G L Jones g.l.jones{at}sheffield.ac.uk
  • Accepted 13 April 2007

A 34 year old woman who attends your surgery has a 12 month history of irregular periods (increasing cycle length). She has never been pregnant. Her mother’s menopause began in her late 30s, and your patient is worried about her own current and future fertility.

What issues you should cover

  • Discuss the possibility of premature ovarian failure, but tell her this is uncommon at age 34 and that other causes of menstrual irregularity—the most common of which would be polycystic ovary syndrome (PCOS) with anovulation—can usually be treated successfully. However, premature ovarian failure does have a familial component, so it is important to exclude this important possible diagnosis, as it has major implications for her future fertility.

  • Ask about her menstrual history: age at menarche, dysmenorrhoea or menorrhagia, cycle length in the past.

  • Ask about signsof PCOS (weight gain, hirsutism, acne, acanthosis nigricans) and family history of diabetes.

  • Consider other causes of oligomenorrhoea …

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