Requires proper evaluation so that the underlying pathology can be diagnosed and specific treatment instituted. Ideally, treatment should be directed at correcting the underlying pathology. Causes, symptoms, and treatment defined in very simple words, amenorrhea is the absence of a menstrual period in a woman during her reproductive age. Upon identification, we reach the specific diagnosis of anemia. Feb 26, 2019 amenorrhea can result from various causes and the treatment of the condition depends mainly on the cause.
Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation breastfeeding, the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method. The chief line of treatment is remedying the underlying disease condition and hormone imbalance. Hypomenorrhea causes, symptoms and treatment womens. Normally, this treatment for oligomenorrhea can be used to cure oligomenorrhea completely. Dysmenorrhea may also be caused by any of the following. Common causes and evaluation amenorrhea, either primary before menarche or secondary after menarche, is a frequently encountered clinical condition in the primary. Amenorrhea not due to pregnancy, lactation, or menopause is a relatively common abnormality of the reproductive years and indicative of a defect somewhere in the hypothalamicpituitaryovarianuterine axis. Menstruation is the discharge of blood and tissue that occurs each month as part of a womans menstrual cycle. Lustig md, msl, in pediatric endocrinology fourth edition, 2014. Nonhormonal and hormonal treatments can be used, depending on the womans desire for pregnancy. Treatment should focus on the restoration of normal nutrition and the administration of hormonal therapy. Iron is a functional component of oxygen transport and energy production in humans and therefore is a critically important micronutrient for sport and exercise performance. If arup consult does not answer your test selection and interpretation questions, or if youd like to suggest ways to improve content or usability, please leave a message for the arup clinical content team. Many menstrual disorders are not a cause for concern, but others require a physician consultation.
Menstrual disorders are problems related to a womans menstrual cycle. Neuroendocrine causes of amenorrheaan update the journal. Transdermal hormonal therapy is preferred over oral hormone replacement therapy. Assessment of secondary amenorrhoea guidelines bmj best. In general, a drug treatment should be given a threemonth trial before changing to another or looking at nonpharmaceutical options. The epidemiology and causes of secondary amenorrhea and overviews of primary amenorrhea and abnormal uterine bleeding in adolescents are discussed separately. It is a type of abnormal uterine bleeding aub abnormal uterine bleeding can be caused by structural abnormalities in the reproductive tract, anovulation, bleeding disorders, hormone issues such as hypothyroidism or cancer of the reproductive tract. An ayurvedic approach to the treatment of secondary. Aug 22, 2017 a condition where a woman has infrequent or irregular menstrual periods is known as oligomenorrhea. Effects on menstruation, fertility, and maternal health. Standard treatment guideline definition of standard. Treatment might range from reassuring patients mild dub in pubertal girls to mutilating surgery in cases of advanced cancers.
The epidemiology and causes of secondary amenorrhea and overviews of primary amenorrhea and abnormal uterine bleeding in adolescents are. Women suffering from this problem also commonly experience vaginal spotting during their periods. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. Diagnosis, management, and treatment 2018 hormone therapy in primary ovarian insufficiency 2017 primary ovarian insufficiency in adolescents and young women 2014 american society for reproductive medicine. Primary amenorrhea is the absence of menstruation for tree months from the time of diagnosis. Outside the reproductive years, there is absence of menses during childhood and after menopause. Treatment is determined by the etiology of the amenorrhea and the desires of the patient. A condition where a woman has infrequent or irregular menstrual periods is known as oligomenorrhea. Menstrual disorders amenorrhea, dysmenorrhea, menorrhagia. Evaluation of amenorrhea, anovulation, and abnormal bleeding. A normal menstrual cycle is between 24 and 38 days long. These will allow development of normal secondary sex characteristics such as breasts and pubic hair.
The majority of the causes of primary and secondary amenorrhea are similar. A detailed history including growth, development including other pubertal signs, especially breast development, nutrition, exercise, weight andor bmi changes, sexual history, firstdegree relatives ages at menarche, medical conditions including chronic disease, and medications. Timing of the evaluation of primary amenorrhea recognizes the trend to earlier age at. Factors such as excess weight, excessively low weight, poor health and lack of exercise can compound the problem. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may 2020. Therefore, it is important that the origin of amenorrhea is established during the. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.
Evaluation and treatment a thorough history and physical examination as well as laboratory testing can help narrow the differential diagnosis of amenorrhea. Discussion of treatment, therefore, must be of necessity general in scope. Treatment for your daughters amenorrhea will depend on whats causing it, but most conditions that cause amenorrhea can be treated with medication and lifestyle changes. Choose from 500 different sets of amenorrhea flashcards on quizlet. Amenorrhoea is the transient or permanent absence of menstrual flow. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications.
Herbal treatment of oligomenorrhea by natural herbs is given in repertory format. Feb 03, 2020 dysmenorrhea is painful menstrual cramps at or around the time of your monthly period. A vaginal, external genital and pelvic examination may be appropriate, depending on the history. There is no consensus on the definition of amenorrhea, but it may be subdivided into primary and secondary presentations relative to menarche as follows. She may ask you to carry out a battery of tests to. Algorithm for the evaluation of primary amenorrhea. Oligomenorrhea herbal treatment, prevention, symptoms, causes. In some cases, contraceptive pills or other hormone therapies can restart your menstrual cycles. This chapter considers the various causes of amenorrhea and their treatment. Current evaluation of amenorrhea the practice committee of the american society for reproductive medicine birmingham, alabama amenorrhea is the absence or abnormal cessation of the menses. Athletes, particularly female athletes participating in endurance sport, are at increased risk of compromised iron status due to heightened iron losses through menstruation and exerciseinduced mechanisms associated with. Although attributes overlap between the two groups, the diagnostic approa. Amenorrhea is the transient or permanent absence of menstrual flow. Treatment of menorrhagia should be initiated in the primary care setting when clinical findings are normal.
The first aim is to establish whether the anemia is microcytic, normocytic or macrocytic. Amenorrhea can result from various causes and the treatment of the condition depends mainly on the cause. Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age. Diagnostic approach and treatment considerations article pdf available in the nurse practitioner 429. Hypomenorrhea is a condition in which a person suffers from very scanty discharge during her menstrual periods. In the case of outflow tract abnormalities eg, imperforate hymen, surgery may be indicated. However, at age years, if no menses have occurred and there is a complete absence of secondary sexual characteristics such as breast development, evaluation for primary amenorrhea should. Apr 03, 2018 menstrual disorders are problems related to a womans menstrual cycle. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she. Polymenorrhea is a term used to describe a menstrual cycle that is shorter than 21 days. Amenorrhea in adolescents clinical evaluation and causes. This article discusses secondary amenorrhea and provides a systematic approach to its diagnostic evaluation, with referral considerations.
Heavy menstrual bleeding, previously known as menorrhagia, is a menstrual period with excessively heavy flow. Treatment goals for patients with amenorrhea may vary considerably, and depend on the patient and the specific diagnosis. May 16, 20 this is a short tutorial by paul miller, md for medical students and residents explaining the definition, process and findings of secondary amenorrhea. A diagnostic evaluation for hypothalamic amenorrhea should be considered in adolescents and women who persistently exceed 45 days between menstrual cycles andor those who present with amenorrhea for 3 months or more after the healthcare provider has excluded other conditions that could be causing amenorrhea. Amenorrhea pediatrics clerkship the university of chicago. Some women experience lighter and lighter periods for three to six months after they begin. Your body normally produces chemicals each month to help your uterus contract. Polycystic ovarian syndrome pcos the association of hyperandrogenism and oligomenorrhea or amenorrhea in females, termed pcos, is a frequent comorbidity of obesity, which can extend down to childhood. Each method should be used for a minimum period of 3 months and preferably six months. Normal menstruation starts at the age of 12, but the range can vary. Insulinlike growth factor 1 and leptin should be also administered to these patients.
The duration of the menstrual period may also become shortened as a consequence of this problem. Scribd is the worlds largest social reading and publishing site. Oligomenorrhea herbal treatment, prevention, symptoms. Evaluation of secondary amenorrhea bmj best practice. The initial evaluation of primary amenorrhea should include. Irregular or absent menstrual periods should trigger an evaluation to identify the root cause. It also considers the diagnosis and treatment of abnormal uterine bleeding at all stages of life.
If a woman goes more than 90 days without a period, then she is diagnosed as having oligomenorrhea. Prompt evaluation and treatment are essential to prevent loss of bone mass due to hypoestrogenemia and or to achieve the timesensitive treatment goal of conception. They are among the most common conditions in women. Under the nhm, financial and technical support is provided to the states and union territories not only for provision of essential drugs mostly all generic, free of cost, in public health facilities but also for strengthening or setting up robust systems of procurement, quality assurance mechanism, warehousing, prescription audit, grievance redressal, dissemination of standard treatment. Although attributes overlap between the two groups, the diagnostic approach. There is no consensus on the definition of amenorrhoea, but it may be subdivided into primary and secondary presentations relative to menarche as follows. Prompt evaluation and treatment are essential to prevent loss of bone mass due to hypoestrogenemia andor to achieve the timesensitive treatment goal of conception. Heres the flowchart to clinical approach to anemia, however, if you need deep insights, follow our article below. She may ask you to carry out a battery of tests to ascertain the precise cause and start treatment.
If a tumor or structural blockage is causing the problem, surgery may be necessary. Amenorrhea is the absence of a menstrual period in a woman of reproductive age. For example, if the ovaries are not functioning properly, you may be given supplemental ovarian hormones. Background primary amenorrhea is defined as the absence of menses at age 15 years in the presence of normal growth and secondary sexual characteristics. Amenorrhea andreeff, renee edd, ms, mpas, pac journal of the american academy of physician assistants. History of broken relationships, alcoholism or drug addiction and school or social pressures. Oct 14, 2019 a diagnostic evaluation for hypothalamic amenorrhea should be considered in adolescents and women who persistently exceed 45 days between menstrual cycles and or those who present with amenorrhea for 3 months or more after the healthcare provider has excluded other conditions that could be causing amenorrhea.
Oct 14, 2019 treatment is determined by the etiology of the amenorrhea and the desires of the patient. Overt hypothyroidism may be accompanied by oligomenorrhea and anovulation and is sometimes associated with elevated concentrations of prolactin prl, galactorrhea, or an enlarged sella turcica. There may be an unexpected mass arising from the pelvis, and after 16 weeks human chorionic gonadotrophin hcg falls and pregnancy tests are. Most often, this condition is a side effect of hormonal birth control. Assessment of secondary amenorrhoea guidelines bmj. May 02, 2016 evaluation of the development of secondary sexual characteristics is required for primary amenorrhoea. Evaluation and management of secondary amenorrhea uptodate. When too many of these chemicals are made, your uterus contracts too much and causes pain. Evaluation of secondary amenorrhea images bmj best. Treatment of oligomenorrhea consists of balancing the hormone levels in a womans body by prescribing medication.
Diagnosis and treatment of primary amenorrhea in adolescents. Amenorrhea is the absence or abnormal cessation of the menses 1. The etiologic and diagnostic considerations for oligomenorrhea are the same as for secondary amenorrhea. You need to confer with your health care provider gynecologist and understand your causative factor. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she has previously had oligomenorrhoea. This is a short tutorial by paul miller, md for medical students and residents explaining the definition, process and findings of secondary amenorrhea. Most effective herbal treatment for oligomenorrhea and herbs for oligomenorrhea. Hypomenorrhea causes, symptoms and treatment womens health. Menstrual disorders reproductive age in the reproductive age, psychologic causes of menstrual disorers involve marital and sex life, a detailed history might reveal significant events that precedes anovulatory episodes. Apr 11, 2016 the chief line of treatment is remedying the underlying disease condition and hormone imbalance. A thorough understanding of the neuroendocrine causes of amenorrhea and infertility is critical for properly assessing patients presenting with these complaints. Surgical treatment for amenorrhea is not common, but may be recommended in certain conditions.
1438 590 1366 1520 199 787 1100 1157 980 1399 222 762 1234 55 525 998 1408 424 816 856 1049 1068 464 797 582 1064 256 192 1362 968 1341 1003 1406 545 661 574 492 31 629 513 818