Amenorrhea, which is coded as N91 in the ICD-10 system, means not having menstrual periods. Usually, a menstrual cycle happens every 28-35 days. Amenorrhea is diagnosed when a woman hasn’t had her period in these cases:
Primary Amenorrhea: Never getting a period by the age of 15 (or, if breast growth is normal, by the age of 13).
Secondary Amenorrhea: Not having periods for three or more cycles in a woman who used to have regular periods.
This article discusses amenorrhea, its types, causes, how it is diagnosed, and treatment options.
Types of Amenorrhea
The ICD-10 coding system separates primary and secondary amenorrhea:
- Primary Amenorrhea: This occurs when a girl doesn’t begin menstruating during puberty. It can be caused by problems with the reproductive system, hormone imbalances, or genetic factors.
- Secondary Amenorrhea: This is more common and affects women who had regular periods before. Causes include hormonal changes due to stress or weight changes, or other medical conditions.
Causes of Amenorrhea
Amenorrhea, or the absence of menstrual periods, can have many different causes related to the body, anatomy, and environment.
Physiological Causes
- Pregnancy: The most frequent cause of amenorrhea in secondary cases.
- Lactation: Breastfeeding can stop ovulation and periods.
- Menopause: The natural decrease in reproductive hormones as a woman ages.
Pathological Causes
- Polycystic Ovary Syndrome (PCOS): A hormonal problem that makes the ovaries grow larger and develop small cysts.
- Hypothalamic Amenorrhea: Often due to too much exercise, stress, or significant weight loss, leading to lower levels of gonadotropin-releasing hormone (GnRH).
- Hyperprolactinemia: High levels of prolactin, often caused by pituitary tumors.
- Thyroid Disorders: Both overactive (hyperthyroidism) and underactive (hypothyroidism) thyroid glands can disrupt menstrual cycles.
Anatomical Causes
- Asherman’s Syndrome: Scar tissue in the uterus after surgery or infection.
- Müllerian Agenesis: Being born lacking the upper portion of the vagina and the uterus.
- Imperforate Hymen: A membrane obstructing the entry of the vagina.
Medications and Lifestyle Factors
- Medications: Some antipsychotics, chemotherapy medicines, and oral contraceptives can cause amenorrhea.
- Lifestyle: Amenorrhea can also result from obesity, eating problems, and excessive physical activity.
ICD-10 Codes for Amenorrhea
The ICD-10 system categorizes amenorrhea with the code range N91, which covers absent, scanty, and rare menstruation. Here are the specific codes:
- N91.0: Primary Amenorrhea – For girls who haven’t had a period by age 15 (or by age 13 with normal breast development).
- N91.1: Secondary Amenorrhea – For women who used to have regular periods but haven’t had one for three or more cycles.
- N91.2: Amenorrhea, Unspecified – Used when the type of amenorrhea (primary or secondary) is not specified or unknown.
- N91.3: Primary Oligomenorrhea – For infrequent or scanty periods from the start of menstruation.
- N91.4: Secondary Oligomenorrhea – For women who used to have regular periods but now have infrequent or scanty periods.
- N91.5: Oligomenorrhea, Unspecified – Used when the type of oligomenorrhea (primary or secondary) is not specified.
Choosing the Right Code
Choosing the right ICD-10 code depends on the situation:
- If a girl hasn’t started her period by the expected age, use N91.0 (Primary amenorrhea).
- If a woman who used to have regular periods has missed them for three cycles or more, use N91.1 (Secondary amenorrhea).
- If it’s unclear what type of amenorrhea it is, use N91.2 (Amenorrhea, unspecified).
Diagnosis of Amenorrhea
Diagnosing amenorrhea requires a thorough check-up by a doctor. Usually, they will inquire about your past medical history, menstruation, medications, and way of life.
A physical exam may be done to check your overall health and reproductive development. Additional tests may include:
- Pregnancy Test: To determine if the reason is pregnancy.
- Blood Tests: To check hormone levels, including thyroid function, estrogen, progesterone, and prolactin.
- Imaging Tests: Ultrasound or pelvic MRI to look at the uterus, ovaries, and other reproductive organs.
Treatment of Amenorrhea
Treatment for amenorrhea depends on what’s causing it. Here are some common treatments:
- Treating Medical Conditions: If a condition like PCOS or a thyroid disorder is causing amenorrhea, treating that condition can often restore normal periods.
- Hormonal Therapy: Medications like birth control pills or progesterone can help regulate menstrual cycles.
- Lifestyle Changes: Keeping a healthy weight, managing stress, and getting enough sleep can help balance hormones and improve menstrual regularity.
- Weight Management: If amenorrhea is due to weight issues, losing or gaining weight in a healthy way can help normalize hormone levels.
Challenges in Diagnosing and Coding Amenorrhea
Diagnosing and coding amenorrhea can be tricky because of its many possible causes and variations. Here are some challenges:
- Diverse Causes: Amenorrhea can stem from a wide range of factors, making it hard to pinpoint the exact reason without a thorough assessment.
- Similar Symptoms: Symptoms of amenorrhea can be similar to other menstrual issues or health conditions, which complicates diagnosis.
- Individual Differences: Every person is different in how they start puberty and their menstrual patterns, which can affect how amenorrhea is diagnosed.
- Advancing Medical Knowledge: As medical research improves and we learn more about reproductive health, the criteria for diagnosis and how we code amenorrhea may change over time.
Conclusion
Amenorrhea has many causes and needs careful evaluation for personalized treatment. The ICD-10 system helps doctors record and classify amenorrhea, which improves how we care for patients, conduct research, and manage healthcare. Getting the diagnosis and coding right is important for treating patients effectively and helping them get better. As medicine and technology advance, our methods for diagnosing and treating amenorrhea will likely improve, making it easier to handle this complex condition.