Amenorrhea

Abstract

Amenorrhea is an absence of menses. The occurrence of the first menses is called menarche. Its mean age is 12.5years. Amenorrhea is called primary when the patient has never had any episode of menses. It is called secondary, after 3months of amenorrhea, in a patient who has already had menses. In all cases of amenorrhea, pregnancy must be ruled out. The different causes are of hypothalamic-pituitary, ovarian, adrenal or uterine origin. Etiological assessment must be carried out in the absence of menses, at the age of 15years. If there is no breast development, the assessment must be done before the age of 14. In the initial assessment, laboratory tests include hCG, FSH, LH, estradiol (E2), prolactin and testosterone. The pelvic ultrasound is useful in order to measure the ovarian sizes, evaluate the presence of ovarian follicles and a uterus. The diagnostic procedure will discriminate between hypogonadotropic or hypergonadotropic hypogonadism and hyperandrogenism from adrenal or ovarian origin. Physicians should identify the cause of primary or secondary amenorrhea before introducing any treatment.