AMENORRHOEA

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Primary amenorrhoea: no menstruation by 14 years of age in the absence of secondary sexual characteristics; or failure to menstruate by 16 years of age. Secondary amenorrhoea: amenorrhoea for at least 3 months in women with previous normal menses

Investigations

»      Body mass index.

»     Urine pregnancy test.

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»      Pelvic ultrasound.

»     Serum for TSH, FSH, LH, prolactin.

FSH > 15 units/L in a young woman (< 40 years) suggests premature ovarian failure.

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LH/FSH ratio of > 2:1 suggests polycystic ovarian syndrome.

MEDICINE TREATMENT

For treatment of hyperprolactinaemia, hypo- or hyperthyroidism, see Chapter 8: Endocrine System.

If no cause for secondary amenorrhoea is found:

  • Medroxyprogesterone acetate, oral, 10 mg daily for 10 days.

o       Anticipate a withdrawal bleed 5–7 days following conclusion of treatment.

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REFERRAL

»     All cases of primary amenorrhoea.

» Secondary amenorrhoea not responding to medroxyprogesterone acetate.

»      Polycystic ovarian syndrome and premature ovarian failure, for further evaluation.

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