TAILIEUCHUNG - Chaper 8: Amenorrhea

Amenorrhea means the absence of menstruation. Primary amenorrhea is the absence of menarche in a girl aged 16 years or older. Secondary amenorrhea 4 is the absence of menses for 6 months in women with previously irregular cycles or 3 months in women with regular cycles (21–35 days). | 8 Amenorrhea Marieke Lagro INTRODUCTION Amenorrhea means the absence of menstruation. Primary amenorrhea is the absence of menarche in a girl aged 16 years or older. Secondary amenorrhea is the absence of menses for 6 months in women with previously irregular cycles or 3 months in women with regular cycles 21-35 days 1 2. Menarche is the first menstrual period and starts after the development of secondary sexual characteristics pubic and axillary hair and breast development Tanner stages Figure 1 . The mean age of menarche is years but there exist huge differences between and within countries3 4. Generally Figure 1 Tanner stages. Illustration by Michel Komorniczak girls from rural areas in low-resourced countries are older at menarche than girls from urban areas. General living conditions nutritional status physical activity and genetic factors all influence sexual maturation and age at menarche4. HISTORY TAKING In primary amenorrhea Presence of secondary sexual characteristics. Are axillary and pubic hair present and is there breast development see Tanner stages Figure 1 If no secondary sexual characteristics are present there is usually a delay in puberty due to malnutrition stunting chronic childhood illness excessive physical activity combined with reduced energy intake or the delay is constitutional. History of infections especially encephalitis. Encephalitis and meningitis might have damaged the hypothalamus or pituitary. History of abdominal operations. Removal of the ovaries because of tumors cysts or tubo-ovarian abscesses. Age of mother and older sisters at menarche. Late age at menarche is hereditary. Chronic childhood disease and or history of major illness in past 3 years. Chronic debilitating disease can lead to anovulation through hypothalamic dysfunction. Cyclical abdominal pain. Together with an abdominal mass this symptom could indicate a vaginal septum or imperforate hymen. Weight loss. Severe weight loss due to for example a chronic disease

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