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Fertil Steril. 1976 Dec;27(12):1347-58.

The diagnosis and treatment of amenorrheas.

Abstract

Correct diagnosis and treatment of amenorrhea is a challenging problem to the clinician. A systematic approach to the differential diagnosis and treatment, based on functional activity along the hypothalamic-pituitary-ovarian axis, is presented. By obtaining a detailed history, performing a meticulous physical examination, and utilizing several simple clinical and laboratory tests, a correct diagnosis can be reached for the majority of patients. Treatment is relatively simple and geared to the patient's desires. In most instances, understanding of the basic problem helps the patient to cope with it and no treatment is needed. If lack of menses is a problem, cyclic bleeding at regular intervals can be induced. When fertility is a problem, ovulation can be induced, provided that there is no ovarian failure. By spending sufficient time with the patient, paying attention to detail, and giving some thought, a correct diagnosis can be reached and adequate treatment given to most amenorrheic patients.

PIP:

Correct diagnosis and treatment of amenorrhea is best based on functional activity along the hypothalamic-pituitary-ovarian axis. A detailed history, a meticulous physical examination, and utilization of several simple clinical and laboratory tests will provide a correct diagnosis for most patients. Treatment is relatively simple and geared to the patient's desires. In most cases understanding of the problem helps the patient to cope, and no treatment is needed. Amenorrhea during early adolescence is considered normal. Absence of signs of puberty by age 16 suggests abnormal ovarian function. Gonadal abnormalities are responsible for about 60% of cases of primary amenorrhea. Extragonadal anomalies account for about 40% of cases of primary amenorrhea. Congenital adrenal hyperplasia is another cause of extragonadal primary amenorrhea. Some of these patients may successfully menstruate and ovulate, but most are amenorrheic or oligomenorrheic. Cyclic bleeding at regular intervals can be induced if lack of menses is a problem. When fertility is a problem, ovulation can be induced if there is no ovarian failure.

PMID:
1001519
[Indexed for MEDLINE]
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