Amenorrhea

Question 0

History questions

Answer 0

Medical

Galactorrhea – r/o pituitary adenoma
Past or present illness
Intense athletic training
Age at menarche
LMP
Menstrual pattern
Events surrounding amenorrhea
Contraceptive use
Gyn / OB procedures (instrumentation, surgery)
Pregnancy hx outcomes, complications

Question 1

Primary vs Secondary

Answer 1

Primary – No spontaneous bleeding by age 14yo. In the absence of secondary sex characteristics or by age 16 in otherwise normal females.
Secondary – absence of 6 mo in women with regular MCs or 12 mo in those with hx of oligomenorrhea.

Question 2

physical exam

Answer 2

General: Habitus and proportion, obesity, body hair extent and distribution.
HEENT: Note excessive facial hair, acne, funduscopic exam, assess thyroid for goiter or nodules.
Breast development: presence of galactorrhea
Abdomen: presence of striae in nulliparous women can mean hypercortisolism.
Genitalia: Tanner stages

Question 3

Management

Answer 3

Labs
Pregnancy test; TSH, Prolactin, FSH, LH, CBC
Management
Anovulation secondary to <progesterone give MPA (medroxyprogesterone acetate) 10 mg qd (or Progesterone (Prometrium) 400 mg bid) for 7-10 days of each month.
Hypoestrogenic women need further evaluation with FSH and LH.