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Amenorrhea

Michelle E Duffelmeyer, MD and Susan McDiarmid, EdD, MS, PA-C Reviewed 05/2023
 


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: ce...

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 on OvidMedline] ...

ADDITIONAL READING

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

SEE ALSO

  • Hyperthyroidism; Hypothyroidism, Adult; Osteoporosis and Osteopenia

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

CODES

ICD10

  • N91.1 Secondary amenorrhea

  • N91.2 Amenorrhea, unspecified

  • N91.0 Primary amenorrhea

SNOMED

  • 14302001 Amenorrhea

  • 86030004 Secondary physiologic amenorrhea

  • 8913004 Primary physiologic amenorrhea

  • 444769...

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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