EpistemisOligomenorrhea
Specialty: Gynecology and breast.
Why it occurs
- Polycystic Ovary Syndrome (PCOS)
- Hyperprolactinemia (due to prolactinoma, drugs or primary hypothyroidism)
- Functional hypothalamic amenorrhea (induced by rapid weight loss, extreme physical exercise or chronic stress)
- Transition to menopause (perimenopause)
- Thyroid dysfunction (both hypothyroidism and hyperthyroidism)
Initial workup
Hormonal determination in blood (preferably between days 2 and 5 of the cycle if present): FSH, LH, Estradiol, Prolactinemia, TSH, Free and total Testosterone, DHEA-S, and 17-hydroxyprogesterone. Progesterone challenge test (medroxyprogesterone test to assess endogenous estrogen production). Transvaginal gynecological ultrasound to evaluate ovarian morphology (Rotterdam criteria for PCOS) and endometrial thickness.
red flags
Rapid progression to complete amenorrhea lasting more than 6 months, associated virilization (deep voice, clitoromegaly, rapidly evolving severe androgenic alopecia), refractory persistent headache or visual disturbances (bitemporal hemianopia due to suspected pituitary macroadenoma).
Standard management
- Combined oral contraceptives — of choice to regularize cycles, protect the endometrium from unopposed estrogen stimulation and treat hyperandrogenism
- Micronized progesterone 100-200 mg/day orally for 10 to 14 days each cycle in patients who do not desire active contraception to induce withdrawal bleeding
- Metformin 500-1500 mg/day orally if associated with PCOS with proven insulin resistance
- Cabergoline 0.25-0.5 mg/week orally if hyperprolactinemia is confirmed as the primary cause (note: non-pharmacological treatment includes lifestyle modifications and optimization of body mass index).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 4