eMedicine Specialties > Pediatrics: Surgery > Gynecology

Menstruation Disorders: Differential Diagnoses & Workup

Author: Latha Chandran, MD, MPH, Associate Professor of Pediatrics, Associate Dean for Academic Affairs, Director, Division of General Pediatrics, State University of New York at Stony Brook School of Medicine
Contributor Information and Disclosures

Updated: Jun 10, 2009

Differential Diagnoses

Other Problems to Be Considered

Secondary amenorrhea and oligomenorrhea

Pregnancy
Hormonal contraception
Hypothalamic causes (eg, stress, exercise, eating disorder, chronic illness, drugs, tumor, obesity syndromes)
Pituitary causes (eg, hypopituitarism, tumor, infiltration, infarction)
Ovarian causes (eg, premature ovarian failure)
Androgen excess (eg, polycystic ovarian disease, adrenal hyperplasia, adrenal or ovarian tumor)
Other endocrine causes (eg, thyroid disease, Cushing disease)

Workup

Laboratory Studies

  • Amenorrhea
    • Workup depends on patient history and physical findings.
    • No studies are necessary for constitutional growth delay.
    • Obtain a karyotype if the patient is syndromic or has evidence of ovarian failure.
    • Obtain serum FSH levels. Differentiating central from peripheral causes is important. High levels of FSH indicate ovarian failure or gonadal dysgenesis; low levels indicate hypothalamic or pituitary causes.
    • Obtain a bone age in primary amenorrhea.
    • Obtain a serum prolactin level.
    • Obtain thyroid function tests.
    • Obtain urine beta-human chorionic gonadotropin levels. This is mandatory for secondary amenorrhea.
  • For secondary amenorrhea, consider testing serum LH, serum testosterone, dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone, and serum cortisol.
  • Menorrhagia
    • Test for gonorrhea and chlamydia if patient is sexually active.
    • Obtain a urine pregnancy test.
    • Obtain a CBC count with reticulocyte count.
    • Obtain coagulation studies.
    • Obtain a blood type and cross-match in very severe cases.
    • Also consider testing for thyroid-stimulating hormone (TSH) level, FSH level, serum prolactin, and serum androgens if clinical evidence of hyperandrogenism is present.

Imaging Studies

  • Amenorrhea
    • Consider MRI of the head if CNS symptoms or hyperprolactinemia are present.
    • Consider pelvic ultrasonography if absent uterus or structural anomalies are suspected.
  • Dysmenorrhea: Ultrasonography and MRI may be helpful if secondary cause of dysmenorrhea is suspected.
  • Menorrhagia: Consider pelvic ultrasonography if a mass or structural anomaly is suspected.

More on Menstruation Disorders

Overview: Menstruation Disorders
Differential Diagnoses & Workup: Menstruation Disorders
Treatment & Medication: Menstruation Disorders
Follow-up: Menstruation Disorders
References
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References

  1. Cosgrove L, Riddle B. Constructions of femininity and experiences of menstrual distress. Women Health. 2003;38(3):37-58. [Medline].

  2. Harel Z. Dysmenorrhea in adolescents and young adults: etiology and management. J Pediatr Adolesc Gynecol. Dec 2006;19(6):363-71. [Medline].

  3. James AH, Kouides PA, Abdul-Kadir R, Edlund M, Federici AB, Halimeh S, et al. Von Willebrand disease and other bleeding disorders in women: Consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol. May 28 2009;[Medline].

  4. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG committee opinion. No. 337: Noncontraceptive uses of the levonorgestrel intrauterine system. Obstet Gynecol. Jun 2006;107(6):1479-82. [Medline].

  5. [Best Evidence] Marjoribanks J, Lethaby A, Farquhar C. Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2006;(2):CD003855. [Medline].

  6. Braverman PK, Sondheimer SJ. Menstrual disorders. Pediatr Rev. Jan 1997;18(1):17-25; quiz 26. [Medline].

  7. Emans JS, Laufer M, Goldstein DP. Delayed puberty and menstrual irregularities. In: Pediatric and Adolescent Gynecology. 4th ed. 1998:163-261.

  8. Gordon CM. Menstrual disorders in adolescents. Excess androgens and the polycystic ovary syndrome. Pediatr Clin North Am. Jun 1999;46(3):519-43. [Medline].

  9. Harlow SD, Campbell OM. Epidemiology of menstrual disorders in developing countries: a systematic review. BJOG. Jan 2004;111(1):6-16. [Medline].

  10. Iglesias EA, Coupey SM. Menstrual cycle abnormalities: diagnosis and management. Adolesc Med. Jun 1999;10(2):255-73. [Medline].

  11. Mitan LA, Slap GB. Adolescent menstrual disorders. Update. Med Clin North Am. Jul 2000;84(4):851-68. [Medline].

  12. Slap GB. Menstrual disorders in adolescence. Best Pract Res Clin Obstet Gynaecol. Feb 2003;17(1):75-92. [Medline].

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Further Reading

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Keywords

menstruation disorders, irregularities of menstruation, menstrual disorders, amenorrhea, oligomenorrhea, dysmenorrhea, secondary dysmenorrhea, painful menstruation, menorrhagia, anovulatory cycles, irregular menstrual patterns, thelarche, menarche, dysfunctional uterine bleeding, DUB, menstruation disorders, hypothalamic-pituitary-ovarian axis, HPO axis, endometriosis, pelvic inflammatory disease, uterine fibroids, Crohn disease, constitutional delay of puberty, hypothalamic dysfunction, pituitary failure, gonadal failure, Turner Syndrome, Swyer syndrome, gonadotrophin deficiency, Kallmann syndrome, hyperandrogenic amenorrhea, hypothalamic amenorrhea, hypothyroidism, hyperprolactinemia, outflow tract obstructions, imperforate hymen, vaginal atresia, Müllerian agenesis, androgen insensitivity

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Contributor Information and Disclosures

Author

Latha Chandran, MD, MPH, Associate Professor of Pediatrics, Associate Dean for Academic Affairs, Director, Division of General Pediatrics, State University of New York at Stony Brook School of Medicine
Latha Chandran, MD, MPH is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Elizabeth Alderman, MD, Director of Fellowship Training Program, Director, Adolescent Ambulatory Service, Clinical Professor, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Montefiore Medical Center
Elizabeth Alderman, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Paul D Petry, DO, FACOP, FAAP, Consulting Staff, Freeman Pediatric Care, Freeman Health System
Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD, Assistant Professor of Obstetrics/Gynecology and Pediatrics, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center
Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

 
 
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