STUDY - Technical - New Dacian's Medicine
Amenorrhea
(Classical / Allopathic Medicine)
Amenorrhea, the
absence of menstrual flow, can be classified as primary or
secondary. With primary amenorrhea, menstruation fails to
begin before age 16. Secondary amenorrhea, begins at an
appropriate age but later ceases for 3 or more months in the
absence of normal physiologic causes, such as pregnancy,
lactation, and menopause.
Pathologic
amenorrhea results from anovulation or physical obstruction to
menstrual outflows, such as from an imperforate hymen,
cervical stenosis, or intrauterine adhesions. Anovulation may
result from hormonal imbalance, debilitating disease, stress
or emotional disturbances, strenuous exercise, malnutrition,
obesity, or an anatomic abnormality such as the congenital
absence of the ovaries or uterus. Amenorrhea may also result
from drug or hormonal therapy.
HISTORY:
Ask the patient at what age her mother first menstruated because the age of menarche is fairly consistent in families.
Form an overall impression of the patient's physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
Determine the frequency and duration of the patient's previous menstrual cycles (if any) as well as the onset and nature of changes in her normal menstrual pattern.
Ask the patient if she has noticed associated signs and symptoms, such as breast swelling or weight changes.
Review the patient's medical history, noting especially long-term illnesses, such as anemia, or use of hormonal contraceptives.
Ask the patient about exercise habits, especially running, and ask whether she experiences stress on the job or at home.
Ask the patient about her eating habits, including the number and size of daily meals and snacks.
Ask the patient about recent weight loss or gain.
Ask the patient at what age her mother first menstruated because the age of menarche is fairly consistent in families.
Form an overall impression of the patient's physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
Determine the frequency and duration of the patient's previous menstrual cycles (if any) as well as the onset and nature of changes in her normal menstrual pattern.
Ask the patient if she has noticed associated signs and symptoms, such as breast swelling or weight changes.
Review the patient's medical history, noting especially long-term illnesses, such as anemia, or use of hormonal contraceptives.
Ask the patient about exercise habits, especially running, and ask whether she experiences stress on the job or at home.
Ask the patient about her eating habits, including the number and size of daily meals and snacks.
Ask the patient about recent weight loss or gain.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Observe the patient's appearance for secondary sex characteristics or signs of virilization.
Note the presence of truncal obesity, moon face, or increased pigmentation.
Palpate the abdomen. Note any abdominal tenderness or masses.
Take the patient's vital signs.
Observe the patient's appearance for secondary sex characteristics or signs of virilization.
Note the presence of truncal obesity, moon face, or increased pigmentation.
Palpate the abdomen. Note any abdominal tenderness or masses.
SPECIAL
CONSIDERATIONS:
If the patient has secondary amenorrhea, physical and pelvic examinations must rule out pregnancy before diagnostic testing begins.
If the patient has secondary amenorrhea, physical and pelvic examinations must rule out pregnancy before diagnostic testing begins.
PEDIATRIC
POINTERS:
Adolescent girls are especially prone to amenorrhea caused by emotional upsets, typically stemming from school, social, or family problems.
Adolescent girls are especially prone to amenorrhea caused by emotional upsets, typically stemming from school, social, or family problems.
AGING ISSUES:
In women older than age 50, amenorrhea usually represents the onset of menopause.
In women older than age 50, amenorrhea usually represents the onset of menopause.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing and treatment and answer her questions. Because amenorrhea can cause severe emotional stress, provide emotional support and refer her for psychological counseling, if appropriate.
Instruct the patient on what to expect from diagnostic testing and treatment and answer her questions. Because amenorrhea can cause severe emotional stress, provide emotional support and refer her for psychological counseling, if appropriate.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)