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Amenorrhea, Pediatric

Renee K. Kottenhahn, MD and Deborah B. Ehrenthal, MD, MPH Reviewed 10/2018
 


BASICS

DESCRIPTION

Amenorrhea is the absence of menstruation. It is divided into two categories: 
  • Primary amenorrhea

    • The failure to begin menstruation by 15 years of age in girls with otherwise appropria...

DIAGNOSIS

A stepwise approach to the evaluation, guided by the history and physical exam, is recommended. 
  • Phase 1: Exclude pregnancy by urine or serum β-hCG testing.

  • Phase 2: Obtain a complete menstrua...

TREATMENT

GENERAL MEASURES

Identification and management depends on the underlying disorder. Premature use of hormonal therapy may alter subsequent testing and should be discouraged. 

MEDICATION

  • Medical ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Most patients with amenorrhea can be managed in an outpatient setting. 

DIET

Address underlying nutritional disorders and bone health. Multidisciplinary support may...

ADDITIONAL READING

  • ACOG Committee Opinion No. 651: menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstet Gynecol.  2015;126(6):e143–e146. [View Abstract on Ovid...

CODES

ICD9

  • 626 Absence of menstruation

  • 256.8 Other ovarian dysfunction

ICD10

  • N91.2 Amenorrhea, unspecified

  • N91.0 Primary amenorrhea

  • N91.1 Secondary amenorrhea

  • E28.8 Other ovarian dysfunction

SNOMED

  • 14302001 Am...

FAQ

  • Q: Does a patient who says she has never had sexual intercourse still need a pregnancy test?

  • A: Yes.

  • Q: What menstrual patterns should patients expect after stopping hormonal contraception?

  • A: Normal...

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