Amenorrhea clinical presentation

Describe the clinical presentation of amenorrhea, menorrhagia, anovulatory bleeding, dysmenorrhea, and premenstrual dysphoric disorder. 

Elevated prolactin serum concentrations inhibit gonadotropin secretion and sex-steroid synthesis. Because prolactin concentrations higher than 60 mcg/L are associated with anovulation, women with hyperprolactinemia typically present with menstrual irregularities such as ohgomenorrhea or amenorrhea and infertility. In addition, approximately 40% to 80% of women with hyperprolactinemia will have galactorrhea. The clinical presentation of patients with hyperprolactinemia is summarized in Table 75-5. ... 

Although most notable in Stein-Leventhal syndrome, which comprises the classical findings of amenorrhea, hirsutism, obesity, and sclerotic ovaries, a wide range of clinical presentations exist. Only one-quarter to one-half of the patients present the classical signs. Usually, infertility is the leading clinical problem of patients with PCOS. Recently, ultrasonographic studies reported a prevalence of polycystic ovaries in young women of at least 20%. However, there seems to be an overlap of polycystic ovaries and normal ovaries [62]. 

In polycystic ovarian disease, both of the generally enlarged ovaries contain many small follicular cysts (2-6 mm), but larger cysts may also be present. Polycystic ovarian syndrome (Stein-Leventhal syndrome) is characterized by the association of polycystic ovaries with irregular menses, prolonged uterine bleeding, amenorrhea, anovulation, and often hirsutism and obesity. The clinical manifestation of this syndrome begins at or shortly after puberty. 

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