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Approach to Amenorrhea: Causes, Investigation, and Treatment

Understand the causes of primary and secondary amenorrhea, along with the history, physical exam, and investigations required. Learn about treatment options for different conditions leading to amenorrhea.

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Approach to Amenorrhea: Causes, Investigation, and Treatment

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  1. AMENORRHEA • APPROACH TO AMENORRHEA • Primary Amenorrhea? • ❏ absence of menses by age 15 • OR • Secondary Amenorrhea? • ❏ absence of menses for >6 months after documented menarche

  2. History and Physical • Tanner staging • breasts present? • uterus present? • r/o possibility of pregnancy

  3. Causes of Primary and Secondary Amenorrhea • AnatomicOvarian FailureEndocrineOther• • pregnancy • • menopause • • hypothalamic/pituitary tumours • stress • Adhesion • surgery, radiation, chemotherapy

  4. Hyperprolactinemia • Anorexia • gonadal dysgenesis• • chromosomal• isolated gonadotropin deficiency • (absent uterus, ovaries• Turner Syndrome (XO)

  5. Hyperandrogenism • illnesspresent) • Androgen Insensitivity • exercise • imperforate hymenSyndrome (XY) • Ovarian/adrenal tumour • vaginal septum • Testosterone injections • Hypothyroidism • Cushing Disease

  6. Investigation • medroxyprogesterone acetate (Provera) 10 mg for 10 days • if withdrawal bleeding occurs —> adequate estrogen • if no bleeding occurs —> hypoestrogenism • karyotype if indicated • U/S to rule out cyst, polycystic ovarian disease

  7. Treatment • hypothalamic dysfunction • stop drugs, reduce stress, adequate nutrition, and decrease excessive exercise • clomiphene citrate (Clomid) if pregnancy desired • otherwise BCP to induce menstruation • hyperprolactinemia • bromocriptine • surgery for macroadenoma

  8. premature ovarian failure • treat associated autoimmune disorders • HRT to prevent osteoporosis and other manifestations of hypoestrogenic state • hypoestrogenism • karyotype • removal of gonadal tissue if Y chromosome present

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