Amenorrhea: A Systematic Approach to Diagnosis and Management

Abstract

Amenorrhea, the absence of menses, occurs in approximately 3 to 4% of women.4,7 It may be present as primary amenorrhea (the absence of menarche) or secondary amenorrhea (the absence of menses after menarche). The evaluation of the patient with amenorrhea requires an understanding of female anatomy and embryology as well as the hypothalamic-pituitary-ovarian axis. A logical systematic approach to adolescents and women with amenorrhea leads to the appropriate diagnosis and management. When considering the appropriate evaluation and management of amenorrhea, several classification schemes may be considered. The following review outlines the necessary background to understand the various clinical conditions.  In addition, the step-wise approach to diagnosis and management is presented. This review contains 4 figures, 3 tables, and 45 references.  Key Words: amenorrhea, anomalies, embryologic development, hyperandrogenism, hyperprolactinemia, hypothalamic dysfunction, ovarian insufficiency, puberty, thyroid dysfunction