EVALUATION AND MANAGEMENT OF AMENORRHEA

All women who enter menopause experience amenorrhea unless they receiv e hormone replacement therapy, In younger women, amenorrhea unrelated to pregnancy and lactation can be a distressing symptom. In addition t o its psychologic morbidity, amenorrhea mag be the manifesting feature of a wide array of anatomic and endocrine abnormalities, Amenorrhea r esults in impaired fertility, When estrogen levels are low, changes in mineral, glucose, and fat metabolism accompany amenorrhea, These meta bolic changes affect bone and cardiovascular health, increasing the ri sk of osteoporosis and coronary heart disease in later life, Amenorrhe a with hyperandrogenism, most commonly caused by the polycystic ovaria n syndrome, may cause endometrial hyperplasia and increases the risk o f endometrial adenocarcinoma, Because of the broad differential diagno sis of amenorrhea, establishing an accurate diagnosis can prove challe nging, In this article, we outline one approach to the assessment of p atients with amenorrhea and to the management of its common causes and consequences.