GuidelinesEML (Adult Hospital STG)
Amenorrhoea
Description Medicine Treatment Referral ICD-10 code: N91.0-2 DESCRIPTION Primary amenorrhoea: no menstruation by 16 years of age in the presence of secondary sexual characteristics. Secondary amenorrhoea: amenorrhoea for at least 3 months in women with previous normal menses, or for at least 6 months with irregular cycles. Investigations Body mass index. Urine pregnancy test. Pelvic ultrasound. S
ICD-10 code: N91.0-2
DESCRIPTION
- Primary amenorrhoea: no menstruation by 16 years of age in the presence of secondary sexual characteristics.
- Secondary amenorrhoea: amenorrhoea for at least 3 months in women with previous normal menses, or for at least 6 months with irregular cycles.
Investigations
- Body mass index.
- Urine pregnancy test.
- Pelvic ultrasound.
- Serum for TSH, FSH, LH, prolactin.
- FSH > 15 units/L in a woman < 40 years of age suggests premature ovarian failure.
- LH/FSH ratio of > 2:1 suggests polycystic ovarian syndrome.
MEDICINE TREATMENT
For treatment of hyperprolactinaemia, hypo- or hyperthyroidism, see Chapter: Endocrine System.
Progestin challenge test:
If no cause for secondary amenorrhoea is found:
- Medroxyprogesterone acetate, oral, 10 mg daily for 10 days.
- Anticipate a withdrawal bleed 5–7 days following conclusion of treatment.
REFERRAL
- All cases of primary amenorrhoea.
- Secondary amenorrhoea not responding to medroxyprogesterone acetate.
- Polycystic ovarian syndrome and premature ovarian failure, for further evaluation.
Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 5: Gynaecology; Version 1.0, 2020-4_June 2024