Clinical Pearls

The two most common causes of secondary amenorrhea after postpartum hemorrhage are Sheehan's syndrome and intrauterine adhesions.

A pregnancy test should be the first test in evaluating a woman with secondary amenorrhea.

Normal function of the anterior pituitary points toward intrauterine adhesions.

Hypothyroidism or a monophasic basal body temperature chart suggests Sheehan's syndrome.

Treatment of Sheehan's syndrome is replacement of the hormones governed by the anterior pituitary gland.

The most common cause of ovulatory dysfunction in a reproductive-age woman is polycystic ovarian syndrome, which is characterized by obesity, anovulation, hirsutism, glucose intolerance, and estrogen excess.


Mishell DR. Primary and secondary amenorrhea. In: Stenchever MA, Droegemueller W. Herbst AL. Mishell DR. eds. Comprehensive gynecology, 4th ed. St. Louis: Mosby-Year Book, 2001:1099-1124. Laufer LR. Patel KS. Amenorrhea, oligomenorrhea, and hyperandrogenic disorders. In: Hacker NF, Moore JG. Gambone JC. eds. Essentials of obstetrics and gynecology. 4th ed. Philadelphia: Saunders, 2004:398^08.

A 22-year-old G3 P2 at 40 weeks' gestation complains of strong uterine contractions. She denies leakage of fluid per vagina. She denies medical illnesses. Her antenatal history is unremarkable. On examination, her blood pressure is 120/80, heart rate 85 bpm, and temperature is 98°F. The fetal heart rate ranges from 140 to 150 bpm. The cervix is 5 cm dilated, and the vertex is at -3 station. Upon artificial rupture of membranes, fetal bradycardia ranging from 70 to 80 bpm is noted for 4 min without recovery.

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