Part 2 book “Family practice guidelines” has contents: Gynecologic guidelines, sexually transmitted infections guidelines, infectious disease guidelines, systemic disorders guidelines, musculoskeletal guidelines, rheumatological guidelines, psychiatric guidelines, neurologic guidelines, and other contents. | 14 Gynecologic Guidelines Amenorrhea Rhonda Arthur Definition Amenorrhea is absence of menstruation when menstrual periods should occur. A. Primary amenorrhea 1. No menstrual period by age 14 years in the absence of growth or development of secondary sexual characteristics 2. No menstrual period by age 16 years regardless of the presence of normal growth and development with the appearance of secondary sexual characteristics B. Secondary amenorrhea: No menstrual period for 6 months in a woman who usually has normal periods, or for a length of time equal to three-cycle intervals in a woman with less-frequent cycles. Incidence A. Amenorrhea in a woman who has had menstrual periods is quite common at some time during her reproductive life. Amenorrhea that is a result of agenesis of part of the reproductive system or a chromosomal anomaly is quite rare. See the following for the incidence of each cause. Pathogenesis A. Physiological: Pregnancy, breastfeeding, and menopause B. Disorders of the central nervous system (hypothalamic): Hypothalamic amenorrhea is the most common cause of amenorrhea (28%). There is a deficiency in pulsatile secretion of gonadotropin-releasing hormone (Gn-RH). Examples include a stressful lifestyle (10%); weight loss as in anorexia or bulimia (10%); extreme exercise; medications, such as hormones, as in postpill amenorrhea; hypothyroidism (10%); and major medical disease such as Crohn’s disease or systemic lupus erythematosus (SLE). C. Disorders of the outflow tract or uterine target organ: Abnormalities in the systems of this compartment are uncommon. Examples include Asherman’s syndrome from inadvertent endometrial ablation during dilation and curettage (D&C; causes 7% of amenorrhea); and agenesis or structural anomalies of the uterus, tubes, or vagina. D. Disorders of the ovary: Examples include abnormal chromosomes such as Turner’s syndrome (); normal chromosomes (10%) such as in gonadal dysgenesis or agenesis (there may be no or .
