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Amenorrhea, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Absence of menstruation

  • Primary amenorrhea:

    • No spontaneous uterine bleeding by age 16 yr or within 5 yr of breast development, which should occur by age 13.

  • Secondary amenorrhea:

    • Absence...

Diagnosis

Signs and Symptoms

History

  • Menarche and menstrual history

  • Sexual activity

  • Exercise, weight loss

  • Chronic illness

  • Medications

  • Previous CNS radiation or chemotherapy

  • Family history

  • Infertility

Physical Exam

Treatment

Pre-Hospital

If amenorrhea is the result of pregnancy, stabilize patient as appropriate for pregnancy. 

Ed Treatment/Procedures

Reassurance and referral for follow-up 

Medication

Defer for gyneco...

Follow-Up

Disposition

Admission Criteria

No need for admission unless concern for ectopic pregnancy 

Discharge Criteria

Discharge with appropriate referral. 

Issues for Referral

Referral to gynecology 

Followup Recommendations

Pearls and Pitfalls

  • Pregnancy is the most relevant etiology of amenorrhea in the emergency department.

    • Urine pregnancy test (UPT) may give false negative with low urine specific gravity.

    • UPT sensitivity...

Additional Reading

  • Heiman  DL. Amenorrhea. Prim Care Clin Office Pract.  2009;36:1–17.

  • Lentz  G, Lobo  R, Gershenson  D, et al. Comprehensive Gynecology, 6th ed. Philadelphia, PA: Mosby; 2012.

  • Ro...

Codes

ICD9

  • 256.8 Other ovarian dysfunction

  • 626.0 Absence of menstruation

ICD10

  • N91.0 Primary amenorrhea

  • N91.1 Secondary amenorrhea

  • N91.2 Amenorrhea, unspecified

  • E28.8 Other ovarian dysfunction

SNOMED

  • 14302001 ...

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