Common problems associated with amenorrhea may also require treatment, including For infertility if pregnancy is desired, inducing ovulation Treating symptoms and long-term effects of estrogen deficiency (eg, osteoporosis, cardiovascular disorders, vaginal atrophy) Treating symptoms and managing long-term effects of estrogen excess (eg, prolonged bleeding, persistent or marked breast tenderness, risk of endometrial hyperplasia and cancer) Minimizing hirsutism and long-term effects of androgen excess (eg, cardiovascular disorders, hypertension) Key Points Primary amenorrhea in patients without normal secondary sexual characteristics is usually caused by ovulatory dysfunction (eg, due to a genetic disorder).