Letters to the Editor

An Overlooked Cause of Amenorrhea and Infertility


Am Fam Physician. 2002 Oct 1;66(7).

to the editor: I would like to share a recent experience I had in my practice. A 42-year-old woman presented for her annual physical examination. Before entering the examination room, I reviewed her history: she had remarried three years ago, and she and her new husband had wanted to try for a pregnancy. She had been amenorrheic and had seen another family physician for counseling and an obstetrician-gynecologist for initial infertility evaluation. I had guided her through therapy with clomiphene citrate (Clomid).

By the time of this recent visit, she and her husband had given up on having a child long ago. I had her raise her left arm above her head for a breast examination and noticed a Norplant device on the under surface of her arm. When I asked her about it, she said, “I had completely forgotten about it.” I removed the Norplant this week, shared the story with the multiple other physicians involved in her infertility counseling (with her permission), and have learned to look for this forgotten cause of amenorrhea and infertility in future patients.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

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This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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