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A 26 year-old woman comes to clinic for evaluation of abnormal menses. After having previously irregular menses, she now reports a 9-month history of amenorrhea. She and her husband are now interested in having a child.
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- What additional questions would you ask to characterize her abnormal menstrual cycles?
- Which questions will help you diagnose the major causes of amenorrhea?
- What clues would you look for on physical examination?
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Amenorrhea, the absence of menses, is a common problem in the primary care setting. This condition may be transient, intermittent, or permanent, and usually results from congenital, neuroendocrine, or anatomic abnormalities. The first diagnostic step is determining whether amenorrhea is primary (before menarche) or secondary (after menarche).
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Primary amenorrhea is the absence of menses by age 16 in the presence of otherwise normal secondary sexual characteristics or by age 14 if secondary sexual development has not occurred. Secondary amenorrhea is the absence of menses for 3 months in a woman with previously normal menses or 9 months in a woman with oligomenorrhea (light or infrequent menses).1
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A thorough history and physical examination helps narrow the differential diagnosis prior to ordering any laboratory tests or studies.
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Primary amenorrhea in the United States has a prevalence of 0.3%. Secondary amenorrhea is much more common, with a prevalence of 3.3% (excluding pregnancy).2 Once pregnancy has been ...