ACTIVITY NUMBER: RES007
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, 2013
Reviewed and Updated in 2015
Expiration Date: January 31, 2019
Under Review July 2022
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. Describe the classification of amenorrhea.
2. List the major causes of primary and secondary amenorrhea.
3. Elicit a pertinent history to evaluate amenorrhea.
4. List the components of a focused physical examination to evaluate amenorrhea
5. Interpret selected diagnostic tests to evaluate amenorrhea.
6. Treat amenorrhea medically/surgically.
7. 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.
DISCLOSURES FOR PLANNERS
Nancy A. Bowers, BSN, RN, MPH – Nothing to Disclose
Andrew R. La Barbera, PhD, HCLD – Nothing to Disclose
Richard H. Reindollar, MD – Nothing to Disclose
DISCLOSURES FOR FACULTY
Ruben J. Alvero, MD – Nothing to Disclose
Paula Amato, MD – Nothing to Disclose
Alicia Y. Armstrong, MD – Nothing to Disclose
Valerie Baker, MD – Institutional Support from IBSA
Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk
Marcelle I. Cedars, MD – Nothing to Disclose
Bradley S. Hurst, MD – Nothing to Disclose
Helen Kim, MD – Nothing to Disclose
Erica Johnstone, MD – Nothing to Disclose
Emily Jungheim, MD – Consultant for Abbvie, Genentech, Spectrum, Celgene
Lawrence C. Layman, MD – Nothing to Disclose
Richard Legro, MD – Consultant: Euroscreen; Astra Zeneca; Takeda; Clarus Therapeutics; Grant/Research: Astra Zeneca, Ferring
Meredith Loveless, MD – Nothing to Disclose
Elizabeth McGee, MD – Nothing to Disclose
Patricia M. McShane, MD – Consultant, World Egg Bank
Shona C. Murray, MD - Consultant, World Egg Bank
Steven T. Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed
Genevieve Neal-Perry, MD, PhD – Nothing to Disclose
Linda R. Nelson, MD, PhD – Nothing to Disclose
Lubna Pal, MBBS, MS – Research grant from Ferring
Staci E. Pollack, MD – Nothing to Disclose
Robert W. Rebar, MD – Nothing to Disclose
Nanette Santoro, MD – Consultant for QuatRx
James H. Segars, MD – Nothing to Disclose
Cynthia Sites, MD – Nothing to Disclose
Anne Steiner, MD – Nothing to Disclose
Mary D. Stephenson, MD, MSc – Consultant for NoraTherapeutics
Michael Thomas, MD – Consultant: Teva
Kim L. Thornton, MD – Consultant for Parexel
Kimberly Thornton, MD – Nothing to Disclose
Lynn Westphal, MD – Nothing to Disclose
Ellen Wilson, MD – Nothing to Disclose
Bo Yu, MD – Nothing to Disclose
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.