Amenorrhea

Reviewed 06/2017
 


BASICS

DESCRIPTION

  • Primary amenorrhea

  • Gonadal abnormalities

    • ▪ No menses by age 13 to 14 years with absence of secondary sexual characteristics OR
    • ▪ No menses by age 15 to 16 years with normal secondary ch...

DIAGNOSIS

HISTORY

  • Review of systems including weight change, symptoms of pregnancy or menopause, virilizing changes, cyclic pelvic pain, galactorrhea, headaches, vision changes, fatigue, palpitations, ...

TREATMENT

GENERAL MEASURES

Treatment depends on the underlying cause. 

MEDICATION

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

If overtraining is suspected, activity level should be reduced by 25-50%. 

Patient Monitoring

  • Depends on the cause and treatment chosen

  • If hormonal replacement is us...

REFERENCES

Gordon  CM. Clinical practice. Functional hypothalamic amenorrhea. N Engl J Med.  2010;363(4):365–371. [View Abstract on OvidInsights]
Klein  DA, Poth  MA. Amenorrhea: an approach to ...

ADDITIONAL READING

  • Practice Committee of American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril.  2008;90(Suppl 5):S219–S225.

  • Santoro N. Update in hyper- and...

SEE ALSO

  • Osteoporosis; Hyperthyroidism; Hypothyroidism

  • Algorithms: Amenorrhea, Primary; Amenorrhea, Secondary; Delayed Puberty

CODES

ICD10

  • N91.2 Amenorrhea, unspecified

  • N91.0 Primary amenorrhea

  • N91.1 Secondary amenorrhea

  • E28.8Other ovarian dysfunction

ICD9

  • 626.0Absence of menstruation

  • 256.8Other ovarian dysfunction

SNOMED

  • 14302001Amen...

CLINICAL PEARLS

  • First evaluate whether amenorrhea is primary or secondary and exclude pregnancy. TSH and PRL are usual first blood tests.

  • Progestin challenge may cause withdrawal bleed in women with in...

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