Amenorrhea physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Physical examination of patients with amenorrhea is based on underlying disease. Amenorrhea is seen with a number of disorders. The presence of hirsutism and acne on physical examination is suggestive of polycystic ovary disease. The presence of galactorrhea and vision loss on physical examination is suggestive of hyperprolactinemia (prolactinoma). The presence of bulging in vulva and imperforate hymen on physical examination is highly suggestive of imperforate hymen.

Physical Examination

Physical examination of different causes of amenorrhea is as following:[1][2]

Appearance of the Patient

Vital Signs

Neck

Chest

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

Tanner's staging

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 1
 
Prepubertal external genitalia
Prepubertal pubic hair
Growth 5-6 cm/year
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 5
 
Adult external genitalia
Adult type hair with same horizontal distribution ("feminine")
No further height increase after 17 years
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
Tanner staging
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stage 1
 
Prepubertal external genitalia
Prepubertal pubic hair
Growth 5-6 cm/year
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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
 
by:By Tanner_scale-male.svg: M•Komorniczak -talk-, polish wikipedist.derivative work: J.McHardy (talk) - Tanner_scale-male.svg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=9871642
 
 
 
 
 

References

  1. Master-Hunter T, Heiman DL (2006). "Amenorrhea: evaluation and treatment". Am Fam Physician. 73 (8): 1374–82. PMID 16669559.
  2. Chiavaroli, Valentina; DAdamo, Ebe; Diesse, Laura; de, Tommaso; Chiarelli, Francesco; Moh, Angelika (2011). "Primary and Secondary Amenorrhea". doi:10.5772/17675.

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