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Related Subjects: |Male Infertility |Sheehan's syndrome
Investigations of this condition may be divided according to whether secondary sexual characteristics are present or not. If absent, girls should be investigated at the age of 16. If present, investigation can wait until the age of 18.
Amenorrhea Type | Cause | Clinical Features | Investigations | Management |
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Primary Amenorrhea | Turner Syndrome (45,XO) | Short stature, webbed neck, widely spaced nipples, lack of secondary sexual characteristics | Karyotyping, serum FSH and LH levels, pelvic ultrasound | Hormone replacement therapy (estrogen and progesterone), growth hormone therapy |
Androgen Insensitivity Syndrome | Normal breast development, absence of pubic/axillary hair, blind-ending vagina | Karyotyping (46,XY), serum testosterone levels, pelvic ultrasound | Psychological support, gonadectomy after puberty, hormone replacement therapy | |
Müllerian Agenesis (Mayer-Rokitansky-Küster-Hauser Syndrome) | Normal secondary sexual characteristics, absent uterus and upper vagina | Pelvic ultrasound, MRI, karyotyping (46,XX) | Surgical creation of a neovagina, psychological support | |
Kallmann Syndrome | Anosmia, lack of secondary sexual characteristics, delayed or absent puberty | Serum FSH, LH, and testosterone/estradiol levels, MRI of the brain | Hormone replacement therapy (GnRH analogs, estrogen, progesterone) | |
Secondary Amenorrhea | Polycystic Ovary Syndrome (PCOS) | Irregular periods, hirsutism, acne, obesity, insulin resistance | Serum testosterone, LH/FSH ratio, pelvic ultrasound | Weight loss, oral contraceptives, anti-androgens (e.g., spironolactone), metformin |
Hypothalamic Amenorrhea | History of excessive exercise, weight loss, stress, low body fat | Serum FSH, LH, and estradiol levels, thyroid function tests, prolactin levels | Weight gain, stress reduction, possible hormone replacement therapy | |
Premature Ovarian Insufficiency (POI) | Hot flashes, night sweats, vaginal dryness, elevated FSH levels | Serum FSH, LH, and estradiol levels, karyotyping, autoimmune screening | Hormone replacement therapy, calcium and vitamin D supplementation, psychological support | |
Asherman Syndrome | History of uterine surgery, infertility, recurrent pregnancy loss | Hysteroscopy, hysterosalpingography (HSG), pelvic ultrasound | Hysteroscopic adhesiolysis, estrogen therapy post-surgery |