Satisfactory Essays
Amenorrhoea is the absence of menstrual bleeding. It is a normal feature in prepubertal, pregnant and postmenopausal women. Pregnancy is the first to be considered in females with amenorrhoea in reproductive age. In the absence of pregnancy, the challenge is to determine the exact cause of amenorrhoea.
Primary amenorrhoea is difficult to define as there is a great variation in the time of onset of menstruation. However, it coincides well with the development of puberty or secondary sexual characteristics. Undeveloped secondary sexual characteristics at a certain age indicates problem. Therefore, the definition of primary amenorrhoea needs to include the development of secondary sexual characteristics as well. Primary amenorrhoea occurs when there is
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The vaginal length, presence or absence of the uterus and its size as well as the condition of the ovaries can be elicited by performing pelvic examination. Pelvic examination may be inappropriate in young girl who is not sexually active. Per rectal examination gives similar information that is given by pelvic examination.
Laboratory evaluation
The levels of FSH and LH are important in determining the ovarian-axis problems. If history and physical examination findings are suggestive of hyperandrogenism, androgen testings which include testosterone, dehydroepiandrosterone (DHEAS), androstenedione, and 17-OH progesterone to determine the organ of cause (e.g.: adrenal gland or ovary) are helpful. History and examination suggestive of hyperprolactinaemia or thyroid disorders require evaluation of the levels of prolactin and thyroid function.
When the prolactin level is elevated, a magnetic resonance imaging (MRI) of the head is required. This imaging helps in visualising any abnormality in the hypothalamus or pituitary
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