gynecology and obstetrics
Amenorrhea
Key Points
Primary amenorrhea in patients without normal secondary sexual characteristics is usually caused by ovulatory dysfunction (eg, due to a genetic disorder). Always exclude pregnancy by urine or blood tests rather than by history. Primary amenorrhea is evaluated differently from secondary amenorrhea. If patients have primary amenorrhea and normal secondary sexual characteristics, begin testing with pelvic ultrasonography to check for congenital anatomic genital tract obstruction. If patients have signs of virilization, check for conditions that cause androgen excess (eg, polycystic ovary syndrome, an androgen-secreting tumor, Cushing syndrome, use of certain medications). If patients have symptoms and signs ofestrogendeficiency (eg, hot flushes, night sweats, vaginal dryness or atrophy), check for primary ovarian insufficiency and conditions that cause functional hypothalamic amenorrhea. If patients have galactorrhea, check for conditions that cause hyperprolactinemia (eg, pituitary dysfunction, use of certain medications). 