Amenorrhea physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Physical examination of patients with amenorrhea is based on underlying disease. The presence of hirsutism and acne on physical examination is diagnostic of polycystic ovary disease. The presence of galactorrhea and vision loss on physical examination is diagnostic of hyperprolactinemia (prolactinoma). The presence of bulging in vulva and imperforated hymen on physical examination is highly suggestive of imperforate hymen.
Physical Examination
- Physical examination of patients with amenorrhea is based on underlying disease.
- The presence of hirsutism and acne on physical examination is diagnostic of polycystic ovary disease.
- The presence of galactorrhea and vision loss on physical examination is diagnostic of hyperprolactinemia (prolactinoma).
- The presence of bulging in vulva and imperforated hymen on physical examination is highly suggestive of imperforate hymen.
Appearance of the Patient
- Patients with amenorrhea usually appear normal.
- Patients with hyperthyroidism may be restless and agitated, while hypothyroidism patients may be calm and even drowsy.
- Patients with polycystic ovary syndrome and Cushing's disease are obese on appearance.
- Patients with Turner syndrome are short stature on appearance.
- Patients with androgen-secreting tumor have virilization on appearance.
Vital Signs
- Hypothermia may be present in hypothyroidism.
- Hyperthermia may be present in hyperthyroidism.
- Tachycardia with regular pulse may be present in hyperthyroidism.
- Bradycardia with regular pulse may be present in hypothyroidism.
- High blood pressure with normal pulse pressure may be present in 17-betahydroxysteroid dehydrogenase deficiency or Cushing's disease.
Neck
- Webbed neck may be present in Turner syndrome.
- Thyromegaly or thyroid nodules may be present in thyroid diseases.
Chest
- Widely spaced nipples may be present in Turner syndrome.
Abdomen
- Purple striae and significant central obesity may be present in Cushing's disease.
Back
- Buffalo hump may be present in Cushing's disease.
Genitourinary
- Rudimentary or absent uterus may be present in mullerian agenesis or androgen insensitivity syndrome.
- Transverse vaginal septum or imperforate hymen may be present in outflow tract obstruction.
- Undescended testes (as pelvic mass) may be present in androgen insensitivity syndrome.
- Clitoral hypertrophy (clitoromegaly) may be present in androgen-secreting tumor.
Neuromuscular
- Proximal muscle weakness may be present in Cushing's disease.
Extremities
- Easy bruising may be present in Cushing's disease.
Tanner's staging
- Lack of secondary sexual characteristics may be present in primary amenorrhea.
- Presence of secondary sexual characteristics may be present in secondary amenorrhea.
| Stage 1 | Prepubertal external genitalia Prepubertal pubic hair Growth 5-6 cm/year |  | |||||||||||||||||||||||||||||||||||||||||||
| Stage 2 | Enlargement of scrotum and testes; scrotum skin become hyperpigmented and harder Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis Growth 5-6 cm/year |  | |||||||||||||||||||||||||||||||||||||||||||
| Boys | Stage 3 | Enlargement of penis (length at first); further testes growth Darker, coarser, and more curled hair, spreading over pubes Growth 7-8 cm/year |  | ||||||||||||||||||||||||||||||||||||||||||
| Stage 4 | Increased penis size with growth and development of glans; testes and scrotum larger, scrotum skin darker Adult type hair, but smaller area; no spread to medial surface of thighs Growth 10 cm/year |  | |||||||||||||||||||||||||||||||||||||||||||
| Stage 5 | Adult external genitalia Adult type hair with same horizontal distribution ("feminine") No further height increase after 17 years |  | |||||||||||||||||||||||||||||||||||||||||||
| Tanner staging | |||||||||||||||||||||||||||||||||||||||||||||
| Stage 1 | Prepubertal external genitalia Prepubertal pubic hair Growth 5-6 cm/year |  | |||||||||||||||||||||||||||||||||||||||||||
| Stage 2 | Breast bud with elevation of breast and papilla; enlargement of areola Sparse growth of long, slightly pigmented hair, straight or curled, along labia Growth 7-8 cm/year |  | |||||||||||||||||||||||||||||||||||||||||||
| Girls | Stage 3 | Further enlargement of breast and areola; no separation of their contour Darker, coarser and more curled hair, spreading sparsely over junction of pubes Growth 8 cm/year |  | ||||||||||||||||||||||||||||||||||||||||||
| Stage 4 | Areola and papilla form a secondary mound above level of breast Adult type hair, but smaller area than in adult; no spread to medial surface of thighs Growth 7 cm/year |  | |||||||||||||||||||||||||||||||||||||||||||
| Stage 5 | Mature breast: projection of papilla only, related to recession of areola Adult type hair with horizontal distribution ("feminine") No further growth after 16 years |  | |||||||||||||||||||||||||||||||||||||||||||