Amenorrhoea is the absence of menstruation.
There are two classifications:
Primary amenorrhoea - failure to begin menstruation. (0.3% of girls)
Secondary amenorrhoea - the cessation of periods for 6 months or more after previously having had regular menstruation (3% of women)
The management of amenorrhoea depends, of course, on the cause.
*the combined oral contraceptive pill should be given long term to prevent osteoporosis*
PCOS: Combined oral contraceptive pill restores periods, and co-cyprindiol is an anti-androgen and therefore improves symptoms associated with increased testosterone (hirsutism and acne). However, this must be used with caution and after counselling as it can cause an increased risk of thrombosis
Premature ovarian failure: Hormone replacement therapy and counselling. Ovum donation and IVF in patients who want to become pregnant
Prolactinaemia: Bromocryptine or carbergoline. In cases where neither of these treatments work, surgery is indicated
Asherman's Syndrome: Removal of adhesions hysteroscopically followed by insertion of IUD and a 3 month course of systemic oestrogen to prevent more adhesions forming. The patient may also need counselling as pregnancy is unlikely even if periods return
Contraceptive induced: Stop contraception if this is what the patient wants. Discuss how long it will take for periods to return, and discuss other methods of contraception with them if they do not want to become pregnant.
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