Pediatric emergency medicine trisk 1009 1009
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FIGURE 51.1 Strategy for initial diagnostic evaluation of the patient with oligomenorrhea. T,
testosterone; TSH, thyroid-stimulating hormone; FSH, follicle-stimulating hormone; PCOS,
polycystic ovary syndrome.
A common cause for oligomenorrhea or amenorrhea is current or recent use of
a hormonal contraceptive method. A parent may bring their child to a healthcare
provider for complaint of oligomenorrhea; a confidential history may reveal that
the patient is on a hormonal contraceptive method. About half of women using
contraceptive medroxyprogesterone injections for 12 months have amenorrhea;
after 2 years of use, the proportion with amenorrhea is 68%. Amenorrhea also
occurs in about 2% of menstrual cycles among patients taking combined
hormonal contraceptives (pills, rings, patch). Some birth control pills are
packaged for extended use, and the patient may only have withdrawal bleeding
four times a year. However, amenorrhea persisting 12 months after the last
injection of medroxyprogesterone or 6 months after birth control pills, ring, or
patch have been stopped should be evaluated in the standard fashion.
ENDOCRINE ABNORMALITIES
Hyperandrogenism
Polycystic Ovarian Syndrome
Classically, hirsutism, obesity, ovarian enlargement, amenorrhea, or infertility
constitutes the clinical features of polycystic ovary syndrome (PCOS, previously
