Amenorrhea: An Approach to Diagnosis and Management Reference : AFP June 1, 2013 Volume 87, Number 11 AFP Review by Dr Engholm

When to be worried: 13 and no puberty 5 years after initial breast development, no menses 15 years old and no menses

When else should I be worried? No menses any time after having 3 months of regular periods No menses any time after having 6 months of irregular periods

Primary Amenorrhea

Secondary Amenorrhea

Amenorrhea Song If she ain’t got no flow Think XO If she’s short then you know If she’s not then you go To the uterus and then Gonadotropins If there’s no lady part Then you got a good start Androgens you see Have insensitivity If she had her flow and stopped What pills has she popped? Is there a baby up in there? Has she lost her hair? High hormones will tell If the ovaries are well Calculate her BMI Headache gets an MRI If you notice a beard Metformin’s not too weird And when it’s time to phone a friend Think Endocrine