Amenorrhea

Question 1

Amenorrhea Differential

Answer 1

Pregnancy
PCOS
Disordered eating and exercise
Hypothalamic Amenorrhea (stress-induced)
Hypothyroidism
CNS tumor or Pituitary lesion

Question 2

Amenorrhea ROS

Answer 2

LMP and regularity
Birth control
Stress/ Emotionally
Exercise
Breast tenderness or discharge
Nausea
Weight gain or loss
Trying to diet
Spotting
Vaginal Discharge
Skin changes (acne, acanthosis)
Hair loss or Growing hair where shouldn't be
Urinary or bowel changes
Heart changes (fast/ slow)
Feeling too hot/ cold
Surgeries
Mother had problems with lost periods

Question 3

Amenorrhea Exam

Answer 3

Vitals
Skin (armpits)
Thyroid with swallow
Abdomen (masses)
Pelvic Exam
Neuro exam (EOM, visual field, fundi, reflex, coordination, gait)

Question 4

Amenorrhea Plan

Answer 4

Pregnancy test
Hormonal/ Metabolic Studies
-TSH/ free T4
-Prolactin
-LH and FSH
-estradiol
Ultrasound of ovaries
Glucose and insulin levels (PCOS)
Cranial MRI (CNS or pituitary tumor)

Question 5

OMT for Amenorrhea

Answer 5

Sacral rock