RT Book, Section
A1 Hoffman, Barbara L.
A1 Schorge, John O.
A1 Halvorson, Lisa M.
A1 Hamid, Cherine A.
A1 Corton, Marlene M.
A1 Schaffer, Joseph I.
SR Print(0)
ID 1171530391
T1 Amenorrhea
T2 Williams Gynecology, 4e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260456868
LK obgyn.mhmedical.com/content.aspx?aid=1171530391
RD 2024/04/24
AB Evaluation  and  management  of  a  patient  with  amenorrhea  is  common  in  gynecology,  and  the  prevalence  of  pathologic  amenorrhea  ranges  from  3  to  4  percent  in  reproductive-aged  populations  (Bachmann,  1982).  Amenorrhea  has  classically  been  defined  as  primary  (no  prior  menses)  or  secondary  (cessation  of  menses).  Although  this  distinction  does  suggest  a  relative  likelihood  of  finding  a  particular  diagnosis,  the  approach  to  diagnosis  and  treatment  is  similar  for  either  presentation  (Tables  17-1  and  17-2).  Of  course,  amenorrhea  is  a  normal  state  prior  to  puberty,  during  pregnancy  and  lactation,  and  following  menopause.  Evaluation  is  considered  for  an  adolescent:  (1)  who  has  not  menstruated  by  age  15  or  within  3  years  of  thelarche  or  (2)  has  not  menstruated  by  age  14  and  shows  signs  of  hirsutism,  excessive  exercise,  or  eating  disorder  (American  College  of  Obstetrician  and  Gynecologists,  2017d).  Secondary  amenorrhea  for  3  months  or  fewer  than  nine  cycles  per  year  also  is  investigated  (American  Society  for  Reproductive  Medicine,  2008;  Klein,  2013).  In  some  circumstances,  testing  reasonably  may  be  initiated  despite  the  absence  of  these  strict  criteria.  Examples  include  a  patient  with  the  stigmata  of  Turner  syndrome,  obvious  virilization,  or  a  history  of  uterine  curettage.  An  evaluation  for  delayed  puberty  is  also  considered  before  the  ages  listed  above  if  the  patient  or  her  parents  are  concerned.