1. Management of Primary
Amenorrhoea
Amrit Neupane
(8)

2.  Investigations for the cause must begin if
• No menstruation occurs till 13 years of age and
there is the absence female secondary sexual
character.
• At 15 years of age if there are female secondary
sexual characters but menstruation does not
occur.

3. Objectives of Management
 To initiate the menstrual cycle if possible
 To promote the development of female
secondary sexual characters if it hasn’t been
developed.
To enable the female to beget a child.

4. • The treatment or management is mainly
based on the cause.
• The scope of the therapeutic success is very
limited. Thus, counseling is very important.

5. Disease and Malnourished States
• Diabetes mellitus and tuberculosis must be
treated.
• Improvement of the nutritional state is vital.
• Correction of malabsorption and weight loss.

6. Anorexia nervosa
• The weight is brought back to normal first.
• This should initiate menstruation.
• Clomiphene therapy can be used to induce
ovulation if needed.

7. Hypergonadotropic Primary Amenorrhea
 Women with streak ovaries
- To promote female secondary sexual
characters, cyclic estrogen and progesterone is
given.
- The women can bear children with donated
oocyte.
 Testicular feminizing syndrome
- Gonadectomy followed by estrogen therapy.

8.  Turner syndrome
- Short term estrogen and progesterone
 Resistant Ovarian Syndrome and Savage
Syndrome has no treatment.

9. • For Turner syndrome and other ovarian
dysgenesis,
Low dose estrogen (0.625 mg) orally for 25
days.
 Progestin (medroxy progesterone acetate 5
mg daily) for the last 10 days after 13 years of
age.

10. Eugonadotropic Primary Amenorrhoea
• Roki Tansky Syndrome
– Creation of a functional vagina for coital
purposes.
Can bear children through surrogacy.
• Cryptomenorrhoea with Amenorrhoea
- Simple cruciate incision of the hymen if the cause
is intact hymen.
- Excision and vaginoplasty if the vaginal septum is
persistent.

11. Hypogonadotropic Primary Amenorrhoea
 Kallmann’s syndrome
-Pulsatile administration of estrogen and
progestin.
 Hypothalamic-pituitary tumors require
surgical excision.

12. Hypothyroidism
For mild hypothyroidism causing primary
amenorrhoea.
-Hormone replacement therapy is enough.

13. Thank
You………….