Amenorrhea/Oligomenorrhea

 

Amenorrhea is a lack of menstrual flow, while oligomenorrhea decribes cycles of over 35 days.

 

Differential diagnosis

Pregnancy

Hypothalamic dysfunction and low FSH/LH

pituitary dysfunction

ovarian dysfunction

outflow defect

endocrine

drugs

 

Investigations

  • history
  • physical exam
  • lab investigations
  • diagnostic imaging

History

Primary amenorrhea: no periods by age 14 in absence of secondary characteristics, or no menses by age 16 with secondary sexual characteristics

Secondary amenorrhea: no periods for over 6 months, or over 3 cycles, after menarche

 

Questions will depend on possible cause:

hypothalamic or pituitary: galactorrhea, headache, visual changes

ovarian: menopausal symptoms

endocrine: weight change, signs of virilization, hypothyroid/hyperthyroid symptoms

 

medical history

  • puberty (absent - Turner's syndrome)

family history

  • delayed puberty

social history

  • excesrise and diet patterns

Past menstrual history

Age, sexual activity, medical history,

 

 

Physical Exam

External genitalia and vagina: atrophy, clitoromegaly, imperforate hymen, vaginal septum, vaginal agenesis

Lab Investigations

beta-hCG

FSH, LH, androgens, estradiol

progesterone challenge to assess for withdrawal bleeding (normal)

karyotype if absent puberty

Diagnostic Imaging

Ultrasound to assess anatomy and for PCOS

CT or MRI of head if FSH/LH are low