Amenorrhea an approach to diagnosis and management pdf

Amenorrhea an approach to diagnosis and management afp. Initial workup of primary and secondary amenorrhea includes a pregnancy test and serum levels of luteinizing hormone, folliclestimulating. There are a number of steps your doctor will take to determine whether you have amenorrhea. Secondary amenorrhea is defined as the absence of menstrual flow in women with previously normal menstruation. This article discusses secondary amenorrhea and provides a systematic approach to its diagnostic evaluation, with referral considerations. Elicit a pertinent history to evaluate amenorrhea and list the essential.

An initial secondary amenorrhea workup includes thyroid stimulating hormone tsh, prolactin, follicle stimulating hormone fsh, and luteinizing hormone. Nov 14, 2019 what is the definition of amenorrhea, primary and secondary amenorrhea. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. Poth, md, uniformed health services university of the health sciences, bethesda, maryland. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. Amenorrhea is common presenting complain in large number of gynaecological disorders.

Sep 30, 2019 the management of primary amenorrhea may vary considerably depending on the patient and the specific diagnosis. Amenorrhea is the term used when a woman or adolescent girl is not having menstrual periods. The approach to managing females with amenorrhea is dictated by the underlying cause. The absence of menstrual bleeding may represent an anatomic or endocrine etiology. Oligo or anovulation may manifest as menstrual bleeding at intervals of less than 21 days or greater than 35 days legro rs, arslanian sa, ehrmann da, et al.

It is intended primarily for clinicians and is not an exhaustive, comprehensive arrangement of every clinical entity which could be grouped under the heading of primary amenorrhea. Amenorrhea, the absence of menstrual bleeding, can be either primary or secondary. Classification of amenorrhea prepuberty pregnancy related menopause primary secondary amenorrhea physiological pathological 5. The management of primary amenorrhea may vary considerably depending on the patient and the specific diagnosis. Amenorrhea in adults causes and management medical magazine. In most cases, there is plausible treatment for amenorrhea. Sep 16, 2003 prolactin is a pituitary hormone that plays a pivotal role in a variety of reproductive functions. Prolactin is a pituitary hormone that plays a pivotal role in a variety of reproductive functions. Functional hypothalamic amenorrhea is a disorder of chronic anovulation caused by suppression of the hypothalamicpituitary axis from body weight loss, excessive exercise, or stress and may result. A structural cause of secondary amenorrhea is asher. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation breastfeeding, the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method. Using an algorithmic approach to secondary amenorrhea.

Hypothalamic amenorrhea is another condition to consider in evaluating symptoms of polycystic ovary syndrome. Evaluating a patient for secondary amenorrhea and its underlying cause begins with a careful history and physical examination. Primary amenorrhea, which by definition is failure to reach menarche, is often the result of chromosomal irregularities leading to primary ovarian. Although amenorrhea may result from a number of different conditions, a systematic evaluation including a detailed history, physical examination, and laboratory assessment of selected serum hormone levels can usually identify the underlying cause. Treatment depends on the underlying cause of your amenorrhea.

See epidemiology and causes of secondary amenorrhea and evaluation and management of primary amenorrhea and abnormal uterine bleeding in adolescents. Amenorrhea is defined as the absence of menses in a woman in the reproductive age and can be classified into primary or secondary amenorrhea primary amenorrhea is the absence of menstrual blood flow in a woman who is older than 16 years of age with secondary sexual characteristics, or who is older than 14 years and without secondary sexual characteristics, who had. Classification of amenorrhea prepuberty pregnancy related menopause primary secondary amenorrhea physiological. Although amenorrhea may result from a number of different conditions, a systematic evaluation including a detailed history, physical examination, and laboratory.

Amenorrhea etiologic approach to diagnosis augusta. Evaluation and management of primary amenorrhea uptodate. Primary amenorrhea is a symptom with a substantial list of. An occult eating disorder and caloric restriction must be ruled out as a compounding factor. Treatment goals for patients with amenorrhea may vary considerably, and depend on the patient and the specific diagnosis. An approach to diagnosis and management although amenorrhea may result from a number of different conditions, a systematic evaluation including a detailed history. Hyperprolactinemia is a common condition that can result from a number of causes, including medication use and hypothyroidism as well as pituitary disorders. Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Our approach is consistent with the endocrine societys 2017 clinical practice guideline for the diagnosis and treatment of fha. There is also the goal of achieving the normal physiologic levels for menstruation to occur and hopefully, deter future problems with fertility and bone health. Amenorrhea differential diagnoses medscape reference.

Amenorrhea an approach to diagnosis and management afp 20. Diagnosis and treatment of polycystic ovary syndrome. Management often involves a multidisciplinary approach, with a focus on lifestyle modification. Vulvodynia approach diagnosis and treatment hope k. Nov 19, 20 amenorrhea amenorrhea is a term describing the absence of a womans menstrual period during the age when the woman is reproductive. Oct 14, 2019 in the differential diagnosis of primary or secondary amenorrhea, the most important step in diagnosis is to exclude pregnancy. Haefner, md professor, michigan medicine ann arbor, michigan, usa august 19, 2017.

Oligo or amenorrhea should be present for at least 2 years after menarche or primary amenorrhea at age 16. Amenorrhea is defined as the absence of menses in a woman in the reproductive age and can be classified into primary or secondary amenorrhea primary amenorrhea is the absence of menstrual blood flow in a woman who is older than 16 years of age with secondary sexual characteristics, or who is older than 14 years and without secondary sexual characteristics, who had never had menses. Amenorrhea the absence of menstrual bleeding may represent an anatomic or endocrine etiology. Evaluation of primary amenorrhea approach bmj best practice. Three structural entities must be considered the hypothalamopituitary axis, the ovaries, and the uterovaginal outflow tract. In some cases, contraceptive pills or other hormone therapies can restart your menstrual cycles. An approach to diagnosis and management a more recent article on amenorrhea is available. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. Amenorrhea in adolescents newbery pediatric medicine. Menopause is a clinical diagnosis, based on the absence of menses for 12 months.

Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who havent begun menstruation by age 15. Outside the reproductive years, there is absence of menses during childhood and after menopause. What is the definition of amenorrhea, primary and secondary amenorrhea. Functional hypothalamic amenorrhea due to stress is a diagnosis of exclusion. Pdf disruptions in the menstrual cycle are a common complaint in primary care and womens health. The most common etiologies are pregnancy and polycystic ovarian syndrome pcos. Evaluation and management of amenorrhea related to congenital. A systematic approach to diagnosis and management menstrual patterns can be an indicator of overall. It is intended primarily for clinicians and is not an exhaustive, comprehensive arrangement of every clinical entity which could. Polycystic ovary syndrome approach bmj best practice. Serum folliclestimulating hormone fsh is recommended for diagnosis in women under 40 years of age, and may be helpful in women ages 40 to 45 years.

A schematic approach is presented which emphasizes several readily available and inexpensive tests within the capability of most laboratories. The definition amenorrhea is divided into two categories. May be repeated in one month if needed to clarify diagnosis. The overall goals of management of secondary amenorrhea are the same as for primary amenorrhea. Amenorrhea amenorrhea is a term describing the absence of a womans menstrual period during the age when the woman is reproductive. Once pregnancy has been ruled out, a logical approach to women with either primary or secondary amenorrhea is to consider. N2 whether amenorrhea is primary or secondary, identification of the lesion by anatomic site permits a practical approach to etiologic diagnosis and to appropriate management. Feb 06, 2020 management often involves a multidisciplinary approach, with a focus on lifestyle modification.

Klein, md, mph, san antonio military medical center, san antonio, texas. The most important steps in the effective management of mullerian agenesis are correct diagnosis of the underlying condition, evaluation for associated congenital anomalies, and psychosocial counseling in addition to treatment or intervention to address the functional effects of genital anomalies. In the differential diagnosis of primary or secondary amenorrhea, the most important step in diagnosis is to exclude pregnancy. Amenorrhea is the transient or permanent absence of menstrual flow and may be subdivided into primary and secondary presentations, relative to menarche. An evidencebased approach to differential diagnosis henderson mc, tierney lm, jr. H h sinha4 1, 2, 3 senoir resident 4professor abstract. Amenorrhea nursing pocket cards lippincott nursingcenter. Treatment options differ for both primary and secondary amenorrhea. Evaluation and management of secondary amenorrhea uptodate. Because of these varying clinical pictures, classifying amenorrhea according to those symptoms that may occur with it table 1 is helpful in organizing a practical approach to its diagnosis. Intended learning outcomes a student should be able to.

Sanchez s, gelber s, fancher t sanchez, stephany, et al chapter 46. Oct 14, 2019 functional hypothalamic amenorrhea due to stress is a diagnosis of exclusion. Amenorrhea in adults causes and management medical. Disruptions in the menstrual cycle are a common complaint in primary care and womens health. Mar 17, 2011 amenorrhea is the absence or abnormal cessation of the menses physiologial amenorrhea pathologial amenorrhea 3. Pathophysiology and clinical manifestations and evaluation and management of primary amenorrhea and evaluation and management of secondary amenorrhea. Secondary and primary amenorrhea definition, causes, treatment. This is a corrected version of the article that appeared in print. Most cases of secondary amenorrhea can be attributed to polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian. Management the overall goals of management of secondary amenorrhea are the same as for primary amenorrhea.

Secondary amenorrhea testing algorithm arup consult. Multiple tests and repeated measurements are often needed. Secondary amenorrhea is a symptom that can be caused by many pathological states and some patients will not demonstrate an obvious etiology, therefore, correct diagnosis requires a systematic evaluation. Depending on the cause and consequences of the hyperprolactinemia, selected patients require treatment. If a tumor or structural blockage is causing the problem, surgery may be necessary. Although overlapping attributes exist between the two groups, the diagnostic approaches vary significantly. Oestrogendeficient amenorrhea is associated with reduced bone mineral density and increased fracture risk, while oestrogenreplete amenorrhea can lead to dysfunctional.