Management of Primary
Amenorrhoea
Amrit Neupane
(8)
 Investigations for the cause must begin if
• No menstruation occurs till 13 years of age and
there is the absence female...
Objectives of Management
 To initiate the menstrual cycle if possible
 To promote the development of female
secondary se...
• The treatment or management is mainly
based on the cause.
• The scope of the therapeutic success is very
limited. Thus, ...
Disease and Malnourished States
• Diabetes mellitus and tuberculosis must be
treated.
• Improvement of the nutritional sta...
Anorexia nervosa
• The weight is brought back to normal first.
• This should initiate menstruation.
• Clomiphene therapy ...
Hypergonadotropic Primary Amenorrhea
 Women with streak ovaries
- To promote female secondary sexual
characters, cyclic e...
 Turner syndrome
- Short term estrogen and progesterone
 Resistant Ovarian Syndrome and Savage
Syndrome has no treatment.
• For Turner syndrome and other ovarian
dysgenesis,
Low dose estrogen (0.625 mg) orally for 25
days.
 Progestin (medroxy...
Eugonadotropic Primary Amenorrhoea
• Roki Tansky Syndrome
– Creation of a functional vagina for coital
purposes.
Can bear ...
Hypogonadotropic Primary Amenorrhoea
 Kallmann’s syndrome
-Pulsatile administration of estrogen and
progestin.
 Hypothal...
Hypothyroidism
For mild hypothyroidism causing primary
amenorrhoea.
-Hormone replacement therapy is enough.
Thank
You………….
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Management of primary amenorrhoea

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Management of primary amenorrhoea

  1. 1. Management of Primary Amenorrhoea Amrit Neupane (8)
  2. 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. 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. 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. 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. 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. 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. 8.  Turner syndrome - Short term estrogen and progesterone  Resistant Ovarian Syndrome and Savage Syndrome has no treatment.
  9. 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. 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. 11. Hypogonadotropic Primary Amenorrhoea  Kallmann’s syndrome -Pulsatile administration of estrogen and progestin.  Hypothalamic-pituitary tumors require surgical excision.
  12. 12. Hypothyroidism For mild hypothyroidism causing primary amenorrhoea. -Hormone replacement therapy is enough.
  13. 13. Thank You………….

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