• Like
Management of primary amenorrhoea
Upcoming SlideShare
Loading in...5

Management of primary amenorrhoea

Uploaded on


  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads


Total Views
On Slideshare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 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………….