Amenorrhea

Did you know that menstrual abnormalities affect up to 75% of adolescent females and account for a large portion of visits to the doctor as well as for missed school? Dr. Nirupma Sharma, a pediatric hospitalist with prior training in obstetrics and gynecology, joins medical students Mary Beth Mahaffey and Lauren Brewer to discuss evaluation of a common menstrual abnormality, amenorrhea, in a female adolescent patient. Specifically, they will: Define amenorrhea and distinguish between primary and secondary causes. Discuss important aspects of the history and physical exam, as well as interpretation of relevant labs. Review the presentation and initial diagnostic workup of the female athlete triad, also known as functional hypothalamic amenorrhea. Overall, provide guidance for pediatricians in recognizing disorders related to amenorrhea to allow for early detection and promotion of proper treatment and referral when necessary. Special thanks to Dr. Erin Latif and Dr. Rebecca Yang for peer reviewing this episode. FREE CME Credit (requires free sign-up): https://mcg.cloud-cme.com/course/courseoverview?P=0&EID=11408 References: https://www.aafp.org/afp/2013/0601/p781.html https://www.ncbi.nlm.nih.gov/books/NBK279144/ https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/menstruation-in-girls-and-adolescents-using-the-menstrual-cycle-as-a-vital-sign https://pedclerk.uchicago.edu/sites/pedclerk.uchicago.edu/files/uploads/035070025.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435916/ https://www.ncbi.nlm.nih.gov/books/NBK279144/ https://pubmed.ncbi.nlm.nih.gov/6379175/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188290/ https://www.aafp.org/afp/2000/0601/p3357.html https://pediatrics.aappublications.org/content/138/2/e20160922 https://www.acog.org/womens-health/faqs/dysmenorrhea-painful-periods https://pubmed.ncbi.nlm.nih.gov/27423183/ https://pubmed.ncbi.nlm.nih.gov/19609045/ https://www.ncbi.nlm.nih.gov/books/NBK554469/ https://pubmed.ncbi.nlm.nih.gov/32119508/ https://www.ccjm.org/content/85/4/313.long https://www.ncbi.nlm.nih.gov/books/NBK430787/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388220/#b6-oajsm-8-085 https://bjsm.bmj.com/content/48/4/289.long