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Management of primary amenorrhoea
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Management of primary amenorrhoea

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  • 1. Management of Primary Amenorrhoea Amrit Neupane (8)
  • 2.  Investigations for the cause must begin if • No menstruation occurs till 13 years of age and there is the absence female secondary sexual character. • At 15 years of age if there are female secondary sexual characters but menstruation does not occur.
  • 3. Objectives of Management  To initiate the menstrual cycle if possible  To promote the development of female secondary sexual characters if it hasn’t been developed. To enable the female to beget a child.
  • 4. • The treatment or management is mainly based on the cause. • The scope of the therapeutic success is very limited. Thus, counseling is very important.
  • 5. Disease and Malnourished States • Diabetes mellitus and tuberculosis must be treated. • Improvement of the nutritional state is vital. • Correction of malabsorption and weight loss.
  • 6. Anorexia nervosa • The weight is brought back to normal first. • This should initiate menstruation. • Clomiphene therapy can be used to induce ovulation if needed.
  • 7. Hypergonadotropic Primary Amenorrhea  Women with streak ovaries - To promote female secondary sexual characters, cyclic estrogen and progesterone is given. - The women can bear children with donated oocyte.  Testicular feminizing syndrome - Gonadectomy followed by estrogen therapy.
  • 8.  Turner syndrome - Short term estrogen and progesterone  Resistant Ovarian Syndrome and Savage Syndrome has no treatment.
  • 9. • For Turner syndrome and other ovarian dysgenesis, Low dose estrogen (0.625 mg) orally for 25 days.  Progestin (medroxy progesterone acetate 5 mg daily) for the last 10 days after 13 years of age.
  • 10. Eugonadotropic Primary Amenorrhoea • Roki Tansky Syndrome – Creation of a functional vagina for coital purposes. Can bear children through surrogacy. • Cryptomenorrhoea with Amenorrhoea - Simple cruciate incision of the hymen if the cause is intact hymen. - Excision and vaginoplasty if the vaginal septum is persistent.
  • 11. Hypogonadotropic Primary Amenorrhoea  Kallmann’s syndrome -Pulsatile administration of estrogen and progestin.  Hypothalamic-pituitary tumors require surgical excision.
  • 12. Hypothyroidism For mild hypothyroidism causing primary amenorrhoea. -Hormone replacement therapy is enough.
  • 13. Thank You………….