# Absent or scanty menstruation - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Amenorrhea - disease-level clinical article (oligomenorrhea-delayed-menses-full.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text ABSENT OR SCANTY MENSTRUATION 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 Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Amenorrhea - disease-level clinical article (oligomenorrhea-delayed- menses-full.txt) (2026-08) 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 Source StatPearls "Amenorrhea" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)