ACTIVITY NUMBER:  RBP007

ACTIVITY TITLE: Amenorrhea

ACCREDITATION STATEMENT

The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Release Date:  February 1, 2010

Expiration Date: March 31, 2029

Estimated Time to Complete Activity: 1.0 hour

NEEDS ASSESSMENT and IDENTIFICATION OF PRACTICE GAP

Amenorrhea is among the most common reasons for patients presenting for care to the practicing physician. Causes of amenorrhea can range from anatomic obstruction to complex endocrine dysfunction, and represent considerable consequences for the patient, who may be affected across her lifespan. Primary amenorrhea is rare, but the prevalence of secondary amenorrhea in the general population is as high as 5%; and is nearly 80% in some groups, including competitive athletes.¹  As the most common cause of secondary amenorrhea is pregnancy, diagnosis and referral for prenatal care is essential.  In contrast, amenorrhea can indicate an underlying cause of infertility.  For all women, appropriate and timely diagnosis and treatment of amenorrhea are needed, but do not always occur. Interviews with women with spontaneous premature ovarian failure revealed they perceived a need for more aggressive evaluation of secondary amenorrhea and oligomenorrhea. Over half reported visiting a clinician's office three or more times before laboratory testing was performed to determine the diagnosis and over half of them reported seeing three or more different clinicians before diagnosis.²  Amenorrhea is part of the Female Athlete Triad, which also includes eating disorders (EDs) and negative effects on bone health; however, only 17% of gynecologists were able to identify all 3 components in one survey.³  Surveys have found that obstetrician-gynecologists are also not confident in their residency training regarding EDs; significant majorities rated residency training in diagnosing (88.5%) and treating (96.2%) EDs as barely adequate or less.⁴ 

1.       Reindollar RH, Novak M, Tho SP, McDonough PG: Adult-onset amenorrhea: a study of 262 patients. Am J Obstet Gynecol. 1986;155:531-543.

2.       Alzubaidi NH, Chapin HL, Vanderhoof VH, Calis KA, Nelson LM. Meeting the needs of young women with secondary amenorrhea and spontaneous premature ovarian failure. Obstet Gynecol. 2002 May;99(5 Pt 1):720-5.

3.       Troy K, Hoch AZ, Stavrakos JE.  Awareness and comfort in treating the Female Athlete Triad: are we failing our athletes? WMJ. 2006 Oct;105(7):21-4.

This educational activity is designed to address the Unit 5 Reproductive Endocrinology educational objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG) on this topic.

EDUCATIONAL OBJECTIVES

At the conclusion of the educational activity, participants should be able to:

1.       Define amenorrhea.

2.       List the major causes of primary and secondary amenorrhea.

3.       Elicit a pertinent history to evaluate amenorrhea.

4.       Describe the essential elements necessary for the diagnosis of amenorrhea.

5.       Select and interpret appropriate diagnostic tests for amenorrhea.

6.       Explore a stepwise clinical decision-making strategy to identify the underlying cause of amenorrhea and guide appropriate treatment selection.

7.       Describe the medical and surgical treatment of amenorrhea.

8.       Describe the long-term follow-up for a patient with amenorrhea, focusing particularly on the risks for endometrial hyperplasia and hypoestrogenism .

TARGET AUDIENCE

This activity is designed to meet the educational needs of resident physicians in obstetrics and gynecology and other related specialties.

ACGME COMPETENCIES

Medical Knowledge

Patient Care

Interpersonal and Communication Skills

SUCCESSFUL COMPLETION REQUIREMENTS

Successful completion of this educational activity requires the learner to:

·         View a course overview page, containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use, prior to the start of each module.

·         Complete a 10-question pre-exam prior to the module. Learners should note any pre-exam questions answered incorrectly for clarification during module study.  

·         Be given the option of downloading a printed syllabus containing the presentation and narrative.

·         Participate in the interactive activity: Audio narration is synchronized with PowerPoint presentation that can be advanced, stopped or reversed as desired.

·         Complete a 10-question post-exam, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.

·         Complete the evaluation survey.

·         Print certificate of completion.

DISCLOSURE STATEMENT  

It is the policy of ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/speakers participating in this activity are required to disclose any relationships they may have with companies whose products or services could be mentioned, allowing participants to determine the objectivity of the presentations. The content and views presented in this activity are those of the faculty/speakers and do not necessarily reflect those of ASRM. Any discussion of the off-label, experimental, or investigational use of drugs or devices is not allowed. The disclosure statements were reviewed by the CME Subcommittee and the Executive Program Committee of ASRM, and any perceived conflicts of interest were resolved in accordance with the ACCME’s policies and Standards of Integrity and Independence in Accredited Continuing Education.  

PRIOR CONTRIBUTORS AND REVIEWERS  

Ruben J.  Alvero, MD – Nothing to Disclose  

Alicia Y. Armstrong, MD  – Nothing to Disclose  

Valerie Baker, MD  – Institutional Support from IBSA  

Nancy A. Bowers, BSN, RN, MPH  – Nothing to Disclose  

Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk   

Marcelle I. Cedars, MD  – Nothing to Disclose  

Marc Goldstein, MD – Advisory Board: Theralogix  

Elizabeth A. Grill, PsyD – Nothing to Disclose  

Andrew R. La Barbera, PhD, HCLD  – Nothing to Disclose  

Lawrence C. Layman, MD – Nothing to Disclose  

Meredith Loveless, MD – Nothing to Disclose  

Janet McLaren, MD – Nothing to Disclose  

Patricia M. McShane, MD – Nothing to Disclose  

Shona C. Murray, MD - Nothing to Disclose  

Steven T.  Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed  

Staci E. Pollack, MD – Nothing to Disclose  

Randal D. Robinson, MD - Speaker’s bureau for Merck and Teva  

Richard H. Reindollar, MD – Nothing to Disclose  

Nanette Santoro, MD – Consultant for QuatRx  

James H. Segars, MD – Nothing to Disclose  

Mary D. Stephenson, MD, MSc –  Consultant for NoraTherapeutics  

Kim L. Thornton, MD – Consultant for Parexel  

James P. Toner, M.D., Ph.D. -  Research support from Columbia Laboratories  

Mark Trolice, MD – Cryos International – Paid Consultant (Self); Alto Pharmacy – Direct Stockholder (Self)  

Ellen Wilson, MD – Nothing to Disclose  

Bo Yu, MD – Nothing to Disclose  

2025 CONTENT DEVELOPERS  

Heather Burks – Pacific Coast Reproductive Society – Board of Directors (Self)  

LaTasha Craig — Ferring Pharmaceuticals – Paid Consultant (Self)  

Rani Fritz, MD – Cradle Genomics – Medical Advisory Board (Self)  

Ryan Heitmann –  Nothing to Disclose  

Sarah Hmaidan – Nothing to Disclose  

Bradley S. Hurst, MD – Nothing to Disclose  

Patricia Jiminez, MD – Society for Reproductive Investigation – Member of DEI, Early Career, and CME committee*  

Molly Kornfield – Nothing to Disclose  

Dab Lebovic – Ferring Pharmaceutical – Paid Consultant (Self)  

Nora Miller, MD – Nothing to Disclose  

Ariya Mobaraki, MD – Nothing to Disclose  

Amalia Namath, MD – Nothing to Disclose  

Chioma Ogbejesi – Nothing to Disclose  

Pamela Parker, MD – Nothing to Disclose  

Jensen Reckhow, MD – Nothing to Disclose  

2025 COURSE REVIEWERS (* beta-test participant reviewer; not responsible for content)    

Ecam Esencan, MD – Nothing to Disclose*

Heather Hipp, MD – Nothing to Disclose  

Paul Lin, MD – Nothing to Disclose  

Pamela Parker, MD – Nothing to Disclose  

Divah Shah, MD – Nothing to Disclose  

Mark Trolice, MD – Cryos International – Paid Consultant (Self); Alto Pharmacy – Direct Stockholder (Self)  

David Walker – Nothing to Disclose  

ADDITIONAL PRESENTERS AND RESOURCES  

David Lee, MD – Nothing to Disclose  

ASRM STAFF PLANNERS AND DEVELOPERS  

Deidra Cain, DrPH, EdD – (former staff)  

Michelle Landrum, EdD – (former staff)  

Chevis Shannon, DrPH, MBA – Nothing to Disclose  

Harriet Smith, M.Ed - Nothing to Disclose  

STATEMENT OF SUPPORT  

No commercial support has been provided for this activity.   

It is the policy of the ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/authors participating in this activity were required to disclose any relationships they may have with commercial entities whose products or services are used to treat patients so that participants may evaluate the objectivity of the presentations. The content and views presented in this activity are those of the faculty/authors and do not necessarily reflect those of the ASRM or CREOG. Any discussion of off-label, experimental, or investigational use of drugs or devices will also be disclosed. The disclosure statements were reviewed by the Subcommittee for Standards of Commercial Support of the CME Committee of ASRM and any perceived conflicts of interest were resolved in accordance with the policies of the ACCME.

STATEMENT OF SUPPORT

No commercial support has been provided for this activity.