Pediatric emergency medicine trisk 1008 1008
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emergency department (ED) is not warranted. However, the ED physician assures
appropriate follow-up as adolescents who report oligomenorrhea at baseline
(defined as an average cycle length of 42 to 180 days), the developing regular
cycles is guarded and this compliant may be the earliest sign of a medical
condition. After 3 years of follow-up, more than half will continue to have
abnormally long cycles.
Adolescents with oligomenorrhea that has persisted for longer than 2 years
after menarche or that involves three or more cycles longer than 42 days during
the past year are candidates for further diagnostic evaluation, although ordinarily
this can be accomplished in an outpatient setting.
Postpartum
Breastfeeding is a physiologic cause of prolactin secretion and oligomenorrhea.
Iatrogenic
Hyperprolactinemia causing oligomenorrhea and galactorrhea can have several
etiologies: drugs (particularly antipsychotic agents), discontinuation of hormonal
contraceptive agents, stimulation of the breasts, and excessive secretion of
prolactin itself (e.g., primary hypothyroidism, pituitary adenoma). Drugs produce
hyperprolactinemia by blocking pituitary dopamine receptors or interfering in
other ways with dopaminergic or serotoninergic central nervous system pathways.
