Dawaa Reference

Clinical reference

Absent or scanty menstruation

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Amenorrhea - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK482168/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class GS07 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against2 documents
  • No dose - referral pathway, no medicine given in primary care
  • Amenorrhea - disease-level clinical article (oligomenorrhea-delayed-menses-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • No period ever by age 15, or by three years after breast budding, defines primary amenorrhea [absent periods]
  • Absent periods for 3 months or more after previously regular cycles meets one definition of secondary amenorrhea [absent periods]
  • No period for 6 months after at least one prior spontaneous menstruation also meets the definition
  • No breast development by age 13 should prompt work-up for delayed puberty rather than isolated amenorrhea
  • Hot flashes, night sweats, vaginal dryness, and mood swings point to low estrogen behind the missed periods [absent periods · hot flushes · night sweats · vaginal dryness]
  • Excess facial or body hair growth and acne suggest androgen excess behind the irregular cycles [acne]
  • Restrictive eating, heavy exercise, and life stress point toward a functional hypothalamic cause

Signs — what you find (6)

  • A low body weight or recent weight loss is typical of the functional hypothalamic form [weight loss]
  • Short stature with no secondary sexual characteristics strongly suggests gonadal dysgenesis [short stature]
  • Milky nipple discharge on exam points to a raised prolactin level as the cause [nipple discharge]
  • No breast growth at all means estrogen has never reached the tissue; breasts that developed normally imply the ovaries are working
  • Present pubic and underarm hair indicates the ovaries are producing androgens
  • A lower abdominal mass can be an enlarged pregnant uterus or trapped menstrual blood behind an obstruction [abdominal mass]

Tests (4)

  • Initial work-up covers a pregnancy test, FSH, LH, estradiol, prolactin, TSH, and a pelvic ultrasound
  • Low FSH together with low estradiol points to a hypothalamic or pituitary cause of the missed periods
  • High FSH with low estradiol points to the ovaries themselves as the problem
  • Pelvic ultrasound can show a heterogeneous, distended uterus when menstrual blood is trapped behind an outflow obstruction

If not this — what else fits (6)

  • Pregnancy is the most common cause of missed periods and must be excluded first with a urine test
  • An abnormal TSH points to thyroid disease as the cause of the missed periods
  • A raised prolactin level identifies hyperprolactinemia as the cause
  • PCOS typically shows a raised testosterone level with polycystic ovaries on ultrasound
  • A high fasting 17-hydroxyprogesterone points to NCCAH rather than PCOS, while a high DHEAS points to an androgen-secreting adrenal tumor
  • Cyclic pelvic pain, or a past cervical or endometrial procedure, raises suspicion for an outflow tract obstruction

SourceStatPearls "Amenorrhea" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Absent or scanty menstruation as a presenting symptom covers many causes - pregnancy, PCOS, thyroid disease, hypothalamic suppression, and more - so treatment is entirely cause-dependent. The GP's first step is always a pregnancy test, then work-up and referral as needed. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Absent or scanty menstruation as a presenting symptom covers many causes - pregnancy, PCOS, thyroid disease, hypothalamic suppression, and more - so treatment is entirely cause-dependent. The GP's first step is always a pregnancy test, then work-up and referral as needed.

Cautions
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • RED FLAG - Cyclic abdominal pain in amenorrhea indicates potential outflow tract obstruction (imperforate hymen or transverse vaginal septum), while headaches, visual changes, or galactorrhea suggest a central nervous system or pituitary lesion.
  • RED FLAG - Possible pregnancy, or signs of virilisation.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.