Amenorrhea

Thomas A. Waller, MD and Sally Ann L. Pantin, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Primary amenorrhea

    • No menses by age 13 years with absence of secondary sexual characteristics OR

    • No menses by age 15 years with normal secondary characteristics

  • Secondary amenorrhea: ...

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

Identify and correct underlying pathology if possible. 

MEDICATION

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

If excessive exercise is suspected, activity level should be reduced by 25–50%. 

Patient Monitoring

  • Depends on the cause and treatment chosen

  • If hormonal replacement...

REFERENCES

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

ADDITIONAL READING

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

  • Santoro N. Upda...

SEE ALSO

  • Hyperthyroidism; Hypothyroidism, Adult; Osteoporosis and Osteopenia

  • Algorithms: Amenorrhea, Primary (Absence of Menarche by Age 16); Amenorrhea, Secondary; Delayed Puberty

CODES

ICD10

  • N91.2 Amenorrhea, unspecified

  • N91.0 Primary amenorrhea

  • N91.1 Secondary amenorrhea

  • E28.8 Other ovarian dysfunction

ICD9

  • 626.0 Absence of menstruation

  • 256.8 Other ovarian dysfunction

SNOMED

  • 14302001 ...

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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