Description
The evaluation of amenorrhea (absence of menstruation) and oligomenorrhea (infrequent menstruation) involves a thorough assessment of a woman's medical history, physical examination, and targeted laboratory tests. The evaluation aims to identify potential underlying causes, such as hormonal imbalances, polycystic ovary syndrome (PCOS), thyroid disorders, or anatomical abnormalities. Diagnostic approaches may include hormonal assays, pelvic ultrasound, and sometimes MRI to assess the reproductive organs. Early identification and treatment of the underlying cause are essential to restore normal menstrual function and address any associated health risks.
Summary Listen
- Amenorrhea is defined as the absence of menstruation, categorized as primary (no menstruation by age 15) or secondary (absence for 3-6 months with prior regular cycles). Oligomenorrhea is infrequent menstruation (less than nine cycles per year). Menstruation is regulated by the hypothalamic-pituitary-ovarian axis, involving gonadotropin-releasing hormone, FSH, LH, estrogen, and progesterone.
- The presenter covered causes of both primary and secondary amenorrhea, focusing on common cases seen in clinics. Causes are related to FSH levels: Low or normal FSH can indicate hypothalamic issues (weight loss, anorexia) or chronic anovulation/PCOS. High FSH suggests gonadal failure. Other causes include thyroid problems, prolactin issues, and hyperandrogenic states.
- Taking a patient history is essential. First rule out pregnancy. Ask about age of menarche, previous menstrual history, lifestyle changes, weight loss, psychological stress, medication use, chronic illnesses, prior surgeries, family history of early menopause, weight gain, and hirsutism. Examination involves assessing weight, BMI, acne, hirsutism, thyroid issues, breast development, and external genitalia.
- Initial investigations typically include FSH, prolactin, and TSH tests, which can provide substantial diagnostic information. Depending on results, additional tests like estrogen levels, LH, free testosterone, DHEAS, and cortisol may be needed. A pelvic scan helps evaluate uterus size, endometrial thickness, and ovarian issues like PCOS. High prolactin levels warrant an MRI of the brain to check for prolactinoma.
- Management depends on the cause. Lifestyle changes (diet, exercise, stress reduction) are crucial. HRT may be necessary for premature ovarian insufficiency, addressing long-term complications like cardiovascular issues and osteoporosis. Genetic testing is considered in specific cases, particularly related to primary amenorrhea and chromosomal abnormalities.
- Post-pill amenorrhea involves no periods for six months after stopping oral contraceptives. Investigations include FSH, LH, and estradiol levels. Management options include waiting for spontaneous resolution, clomid for fertility, or hormone replacement therapy. Real case examples illustrated diverse presentations and management approaches for various amenorrhea causes.
Sample Certificate
About the Speakers
Dr. Yamini Dhar
Specalist in Obstrectics & Gynaecology, AlZahra Hospitals, UAE
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