Understanding Amenorrhea: This resource provides information on Amenorrhea (absence of menstruation, menstrual cessation), including causes, diagnosis, and treatment options. It covers relevant healthcare, clinical documentation, and medical coding terms for accurate medical records. Learn about diagnostic criteria for Amenorrhea and find resources for healthcare professionals and patients.
Also known as
Menstrual disorders
Covers various menstrual irregularities, including amenorrhea.
Ovarian dysfunction
Includes conditions affecting ovarian function that can cause amenorrhea.
Disorders of puberty
Encompasses delayed or absent puberty, a potential cause of amenorrhea.
Perinatal conditions
Includes conditions affecting the newborn period, sometimes related to maternal amenorrhea.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the amenorrhea primary (never menstruated)?
Yes
Is there a chromosomal abnormality?
No
Is the amenorrhea secondary (cessation after menarche)?
When to use each related code
| Description |
|---|
| Absence of menstruation |
| Irregular periods |
| Heavy or prolonged periods |
Miscoding primary and secondary amenorrhea (N91.0, N91.1) due to insufficient documentation of menarche.
Failure to code the underlying cause of amenorrhea, leading to inaccurate DRG assignment and reimbursement.
Coding amenorrhea (N91.2) without specifying physiological or induced causes impacts data quality and research.
Q: What is the most effective diagnostic workup for secondary amenorrhea in adolescents, considering both common and rare causes?
A: Diagnosing secondary amenorrhea (absence of menstruation for 3 or more cycles in someone who previously menstruated or 6 months in someone who never menstruated) in adolescents requires a systematic approach considering both common and rare etiologies. Start with a detailed history including menstrual history, sexual activity, weight changes, exercise habits, stress levels, and any other relevant symptoms. Physical examination should assess for signs of hyperandrogenism, thyroid dysfunction, and galactorrhea. Initial laboratory tests should include a pregnancy test, thyroid-stimulating hormone (TSH), prolactin, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). If these are normal, consider further investigations such as estradiol, testosterone, dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone, and karyotyping if indicated. Imaging studies like pelvic ultrasound or MRI may be necessary to assess uterine anatomy or identify ovarian pathologies. For persistent amenorrhea without a clear diagnosis, consider referral to a pediatric endocrinologist or gynecologist specialized in adolescent care. Explore how S10.AI can assist in streamlining data collection and interpretation for complex cases of amenorrhea.
Q: How can clinicians differentiate between physiological and pathological causes of amenorrhea when evaluating female athletes?
A: Differentiating between physiological and pathological amenorrhea in female athletes can be challenging. Exercise-induced amenorrhea, a form of functional hypothalamic amenorrhea, is often related to energy imbalance, low body weight, and intense training. It's crucial to assess the athlete's energy availability, menstrual history, training load, and nutritional status. Consider using validated tools like the LEAF-Q (Low Energy Availability in Females Questionnaire) to screen for low energy availability. Pathological causes, like primary ovarian insufficiency or pituitary tumors, require further investigation. Red flags include signs of estrogen deficiency (e.g., hot flashes, vaginal dryness), significant bone loss, or other endocrine abnormalities. While physiological amenorrhea may resolve with adjustments to training and nutrition, pathological causes necessitate targeted medical intervention. Consider implementing a multidisciplinary approach involving sports medicine physicians, dietitians, and endocrinologists for comprehensive management. Learn more about integrating S10.AI into your practice to optimize athlete health and performance.
Patient presents with amenorrhea, defined as the absence of menstruation. The patient reports no menses for [duration]. Primary amenorrhea vs secondary amenorrhea was considered based on menarche status. Patient denies pregnancy (if applicable based on age and sexual history). Differential diagnosis includes physiological causes such as pregnancy, lactation, and menopause, as well as pathological causes including polycystic ovary syndrome (PCOS), hypothalamic amenorrhea, premature ovarian insufficiency (POI), thyroid disorders, hyperprolactinemia, and anatomical abnormalities such as imperforate hymen or Mullerian agenesis. Relevant history was obtained, including menstrual history (age at menarche, cycle length, regularity, flow), sexual history, obstetric history, medication use (including hormonal contraceptives, antipsychotics, and chemotherapy), weight changes, exercise habits, stress levels, and family history of menstrual disorders. Physical examination included assessment of weight, body mass index (BMI), and secondary sexual characteristics. Initial laboratory workup may include a pregnancy test (hCG), thyroid stimulating hormone (TSH), prolactin levels, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and depending on clinical suspicion, androgen levels such as testosterone and DHEAS. Further evaluation may include pelvic ultrasound, karyotyping, or MRI of the brain depending on initial findings. ICD-10 code N21.0 (Absence of menstruation) is documented for billing and coding purposes. Patient education provided on the causes of amenorrhea, potential diagnostic testing, and treatment options. Follow-up scheduled to discuss results and formulate a management plan, which may include hormonal therapy, lifestyle modifications, or referral to a specialist such as a gynecologist or endocrinologist.