Primary amenorrhea, which by definition is failure to reach menarche, is often the result of chromosomal irregularities leading to primary ovarian insufficiency (e.g., Turner syndrome) or anatomic abnormalities (e.g., Müllerian agenesis).Secondary amenorrhea is defined as the cessation of regular menses for three months or the cessation of irregular menses for six months.Patients with Turner syndrome (or variant) should be treated by a physician familiar with the appropriate screening and treatment measures.Treatment goals for patients with amenorrhea may vary considerably, and depend on the patient and the specific diagnosis. Each of these conditions is associated with varying clinical sequelae; thus, it is important to consider a broad differential diagnosis to avoid missing rare or emergent pathology.Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent.
Patients with polycystic ovary syndrome are at risk for glucose intolerance, dyslipidemia, and other aspects of metabolic syndrome.Most cases of secondary amenorrhea can be attributed to polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency. Initial workup of primary and secondary amenorrhea includes a pregnancy test and serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and thyroid-stimulating hormone.Patients with primary ovarian insufficiency can maintain unpredictable ovarian function and should not be presumed infertile. In the accompanying legend, De Lee observes: “Trendelenburg again. Bay Jacobs, MD, Library for the History of Obstetrics and Gynecology in America. Now draw the peritoneum down, bring the bladder into position. Abdominal suture.”Podcasts featuring the editors discussing current and past issues are available. ABOG MOC II: The January 2018 ABOG MOC II article list is now available.It is characterized by hyperandrogenism found on clinical or laboratory examination, polycystic ovaries as suggested by ultrasonography, and ovulatory dysfunction. Early effects of metformin in women with polycystic ovary syndrome: a prospective randomized, double-blind, placebo-controlled trial. Metformin-induced resumption of normal menses in 39 of 43 (91%) previously amenorrheic women with the polycystic ovary syndrome. The Rotterdam Consensus Criteria published in 2003 require the presence of two of the three above conditions for diagnosis, whereas the Androgen Excess Society's 2006 guidelines require hyperandrogenism and either of the remaining two conditions.41. Tan BK, Adya R, Chen J, Lehnert H, Sant Cassia LJ, Randeva HS. Laboratory tests usually reveal low or low-normal levels of serum follicle-stimulating hormone, luteinizing hormone, and estradiol; however, these levels can fluctuate, and the clinical context is the discriminating factor.17 Patients with functional amenorrhea may demonstrate the features of the female athlete triad, which consists of insufficient caloric intake with or without an eating disorder, amenorrhea, and low bone density or osteoporosis.31 These patients should be screened for eating disorders, diets, and malabsorption syndromes (e.g., celiac disease).1Treatment of functional hypothalamic amenorrhea involves nutritional rehabilitation as well as reductions in stress and exercise levels.7 Menses typically return after correction of the underlying nutritional deficit.32 Bone loss is best treated by reversal of the underlying process, and the patient should undergo bone density evaluation and take calcium and vitamin D supplements.7 Although the bone loss is partly secondary to estrogen deficiency, estrogen replacement without nutritional rehabilitation does not reverse the bone loss. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.Combined OCs will restore menses, but will not correct bone density.7, pituitary adenoma, hypothyroidism, or mass lesion compromising normal hypothalamic inhibition.8 Elevated prolactin levels, whatever the cause, inhibit the secretion and effect of gonadotropins, and warrant MRI of the pituitary.8 Exceptions may occur in cases with a clear pharmacologic trigger and relatively low levels of serum prolactin (i.e., PCOS is a multifactorial endocrine disorder, usually involving peripheral insulin resistance. Glueck CJ, Wang P, Fontaine R, Tracy T, Sieve-Smith L. Contact [email protected] copyright questions and/or permission requests.Most pathologic cases of secondary amenorrhea can be attributed to polycystic ovary syndrome (PCOS), hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency.1A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.For information about the SORT evidence rating system, go to https://org/A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.