The treatment is dependent on the cause.
For women who are underweight resulting in amenorrhoea, lifestyle and dietary advice is the mainstay. However, if their oestrogen levels are very low they may benefit from hormone therapy to prevent osteoporosis.
For women with polycystic ovarian syndrome there is no cure as the exact cause for it is still not completely known. However, weight loss in women with high BMI can help the return of more regular menses.
Women not wishing to conceive who are not seeing their menses are usually advised to start hormonal treatment. This is especially important if the menses come less frequently than three-monthly, as this in the longer-term increases the chance of endometrial abnormalities and over the years can increase the risk of endometrial cancer. Therefore, the combined pill or progesterones every three months can be used to provoke a bleed to shed the endometrium. Metformin is a non-hormonal daily treatment which can sometimes be considered. It is important to stress that there are many treatments to help if you are trying to conceive.
Problems with excess facial or body hair are experienced by many women with PCOS. Creams which can be used to slow the growth of the hair, along with laser treatment can help with this. A specific type of the combined pill can also be helpful for symptoms of excess hair growth or acne.
High levels of prolactin normally just requires treatment with medication, rarely is surgery required. A referral to a Specialist in this area, an Endocrinologist, is usual.
Premature ovarian failure is not normally reversible, and this can cause women to consider oocyte donation with fertility treatment if pregnancy is desired. This can be a very difficult diagnosis and extra psychological support may be needed.
Hormone replacement therapy is normally advised either in the form of the combined oral contraceptive pill or hormone replacement therapy to prevent osteoporosis in the long term, which has significant morbidity and mortality compared to the risks of treatment.
Surgery may be required for tumours in the hypothalamus, ovary or adrenal gland, as well as for intrauterine adhesions or problems with cervical stenosis.
If the cause of the amenorrhoea is due to other disease then optimising the control of these medical problems is the key to treatment.
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