RT Book, Section
A1 Simon, Alex
A1 Chang, Wendy Y.
A1 DeCherney, Alan H.
A2 DeCherney, Alan H.
A2 Nathan, Lauren
A2 Laufer, Neri
A2 Roman, Ashley S.
SR Print(0)
ID 1159961994
T1 Amenorrhea
T2 CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 12e
YR 2019
FD 2019
PB McGraw-Hill Education
PP New York, NY
SN 9780071833905
LK obgyn.mhmedical.com/content.aspx?aid=1159961994
RD 2024/04/19
AB ESSENTIALS  OF  DIAGNOSISAmenorrhea  is  literally  defined  as  the  absence  of  menses.Primary  amenorrhea  (seen  in  approximately  2.5%  of  the  population)  is  clinically  defined  as  the  absence  of  menses  by  age  13  years  in  the  absence  of  normal  growth  or  secondary  sexual  development,  or  the  absence  of  menses  by  age  15  years  in  the  setting  of  normal  growth  and  secondary  sexual  development.Traditionally,  evaluation  was  usually  initiated  by  age  16  years  if  normal  growth  and  secondary  sexual  characteristics  were  present,  and  at  age  14  years  if  absent.Because  of  secular  trends  toward  earlier  menarche  over  the  past  half  century,  the  evaluation  should  begin  at  age  15  years,  the  age  when  >  97%  of  girls  should  have  experienced  menarche.The  decision  to  evaluate  should  be  made  with  a  full  understanding  of  the  patient’s  clinical  presentation.Evaluation  should  not  be  delayed  in  the  setting  of  neurologic  symptoms  (suggestive  of  hypothalamic–pituitary  lesion)  or  pelvic  pain  (suggestive  of  outflow  obstruction).Secondary  amenorrhea  is  clinically  defined  as  the  absence  of  menses  for  >  3  cycle  intervals,  or  6  consecutive  months,  in  a  previously  menstruating  woman.The  incidence  of  secondary  amenorrhea  can  be  quite  variable,  from  3%  in  the  general  population  to  100%  under  conditions  of  extreme  physical  or  emotional  stress.Table  56–1  lists  the  most  common  causes  of  secondary  amenorrhea.