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Amenorrea: guidelines and practice

Tatiana Belokrinitskaya

 Statement of the Problem.Amenorrhea is the absence of menstrual bleeding as a result from a number of different conditions. The purpose of this study is to describe the guidelines for the diagnosis and treatment of different types of amenorrhea and relate the major recommendations for the patient management. The ESHRE/ESGE classification system of female genital anomalies (2013) is recommendedto use in cases with amenorrhea due to Congenital malformations of the female genital tract. Turner syndrome is usually accompanied by hypergonadotropichypogonadism and primary or secondary amenorrhea. Estrogen replacement should start between 11 and 12 years of age increasing to adult dosing over 2–3 years, and adding progesterone once breakthrough bleeding occurs or after 2 years of estrogen treatment (European Society of Endocrinology Guidelines, 2017). Functional hypothalamic amenorrhea (FHA) is a form of chronic anovulation, not due to identifiable organic causes, but often associated with stress, weight loss, excessive exercise, or a combination thereof. FHA is a diagnosis of exclusion. 1-stline of therapy is to correct the energy imbalance to improve hypothalamic–pituitary–ovarian axis function, psychological support. 2-nd linefor adolescents and women who have not had return of menses:  short-term use of transdermal E2 therapy with cyclic oral progestin (not oral contraceptives or ethinyl E2) (Endocrine Society Guideline, 2017). Premature ovarian insufficiency is characterised by menstrual disturbance (oligo/amenorrhea) with raised gonadotropins and low estradiolbefore the age of 40. Diagnostic criteria of ESHRE Guideline (2015) are: oligo/amenorrhea for at least 4 months, and an elevated FSH level >25 IU/l on two occasions >4 weeks apart. The chance of spontaneous pregnancy is small, but oocyte donation is an established option for fertility. HRT is indicated for the treatment of estrogen deficiency symptoms and to reduce futurerisk of cardiovascular disease, cognitive impairment, reduced bone mineral density.