Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.
Am Fam Physician. 2019 Jul 1;100(1):39-48.
Menstrual patterns can be an indicator of overall health and self-perception of well-being. Primary amenorrhea, defined as the lifelong absence of menses, requires evaluation if menarche has not occurred by 15 years of age or three years post-thelarche. Secondary amenorrhea is characterized by cessation of previously regular menses for three months or previously irregular menses for six months and warrants evaluation. Clinicians may consider etiologies of amenorrhea categorically as outflow tract abnormalities, primary ovarian insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, sequelae of chronic disease, physiologic, or induced. The history should include menstrual onset and patterns, eating and exercise habits, presence of psychosocial stressors, body weight changes, medication use, galactorrhea, and chronic illness. Additional questions may target neurologic, vasomotor, hyperandrogenic, or thyroid-related symptoms. The physical examination should identify anthropometric and pubertal development trends. All patients should be offered a pregnancy test and assessment of serum follicle-stimulating hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone levels. Additional testing, including karyotyping, serum androgen evaluation, and pelvic or brain imaging, should be individualized. Patients with primary ovarian insufficiency can maintain unpredictable ovary function and may require hormone replacement therapy, contraception, or infertility services. Functional hypothalamic amenorrhea may indicate disordered eating and low bone density. Treatment should address the underlying cause. Patients with polycystic ovary syndrome should undergo screening and intervention to attenuate metabolic disease and endometrial cancer risk. Amenorrhea can be associated with clinically challenging pathology and may require lifelong treatment. Patients will benefit from ample time with the clinician, sensitivity, and emotional support.
月经模式可以作为整体健康和自我幸福感的指标。原发性闭经是指月经终身缺失，如果初潮在 15 岁仍未发生或在初潮后 3 年内仍未发生，则需要进行评估。继发性闭经的特征是先前规律的月经停止 3 个月或先前不规律的月经停止 6 个月，需要进行评估。临床医生可以将闭经的病因分类为流出道异常、原发性卵巢功能不全、下丘脑或垂体疾病、其他内分泌腺疾病、慢性疾病后遗症、生理性或诱导性闭经。病史应包括月经初潮和模式、饮食和运动习惯、是否存在心理社会压力源、体重变化、用药、溢乳和慢性疾病。其他问题可能针对神经系统、血管舒缩、高雄激素或甲状腺相关症状。体格检查应确定人体测量学和青春期发育趋势。应向所有患者提供妊娠试验和血清卵泡刺激素、黄体生成素、催乳素和促甲状腺激素水平评估。其他检查，包括核型分析、血清雄激素评估以及盆腔或脑部成像，应根据个体情况进行。原发性卵巢功能不全的患者可能保持不可预测的卵巢功能，可能需要激素替代治疗、避孕或不孕服务。功能性下丘脑性闭经可能表明饮食失调和骨密度降低。治疗应针对潜在病因。多囊卵巢综合征患者应进行筛查和干预，以减轻代谢疾病和子宫内膜癌风险。闭经可能与具有临床挑战性的病理有关，可能需要终身治疗。患者将受益于与临床医生充分的时间、敏感性和情感支持。
