Secondary amenorrhea secondary amenorrhea is the absence of menses for more than three cycle intervals in women who previously had regular menses, or more than six months in women with history of irregular menses. It is important to consider all causes of secondary amenorrhea in the evaluation of primary amenorrhea. In these conditions, products of menstruation accumulate behind the defect and can lead to cyclic or acute pelvic pain. Pregnancy is an obvious cause of amenorrhea and is the most common reason for secondary amenorrhea. Definition amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina. Treatment options differ for both primary and secondary amenorrhea. Hypothalamic amenorrhea is due to a disruption in the regulator hormones produced by the hypothalamus in the brain. Secondary amenorrhea can occur due to natural changes in the body. This influences hypothalamic function and causes amenorrhea. Secondary amenorrhea american academy of pediatrics. Amenorrhea is the absence or abnormal cessation of the menses 1. However, patients with previously regular cycles are evaluated for secondary amenorrhea if menses have been absent for.
Secondary amenorrhea is due to pregnancy, stress, illness or other causes. Mar 17, 2011 endocrine causes secondary amenorrhea etiology thyroid disorder and cushings disease interfere with the normal functioning of the hypothalamic pituitary ovarian axis present with amenorrhea. Mar 30, 2019 common causes of secondary amenorrhea when a woman who has had normal periods stops getting them include. Amenorrhea is the medical term for the absence of menstrual periods, either over a permanent or temporary basis. Secondary amenorrhea missing three menstrual periods in a row or not having periods for at least 6 months after menstruating normally can result from various causes, such as. Etiology a variety of factors can contribute to secondary amenorrhea including medication use, lifestyle factors. It is often classified as either primary absence of menarche by age 15 years or. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she. The majority of the causes of primary and secondary amenorrhea are similar. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. Find out about what causes amenorrhea, and how it can be treated. There are two types of amenorrhea primary or secondary.
Amenorrhea in teens health encyclopedia university of. While the most common causes of secondary amenorrhea are likely to be functional hypothalamic amenorrhea or polycystic ovary syndrome pcos, disorders with an anatomic or pathologic cause must be ruled out algorithm 1. Amenorrhea or amenorrhoea is defined as an abnormal absence of menstrual bleeding in females of reproductive age. Gonadal dysgenesis, including turner syndrome 43 percent. Secondary amenorrhea may be due either to complete obliteration of the uterine cavity or to stenosis or atresia of the internal os, as proved by radiologic studies. After pregnancy is ruled out, the initial workup should be based on patient history and physical examination. These hormones cause the uterus to build a lining and the ovary to release an egg ovulation. There are the causes that are normal to the woman physiological and abnormal pathological. Other causes of amenorrhea include problems with the reproductive organs or with the glands that help regulate hormone levels. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she has previously had oligomenorrhoea. For a girl to have a period, she needs to have started puberty and have hormone signals from her brain sending signals to her reproductive organs ovaries and uterus. Since only a few studies have focused on the causes of amenorrhea among women in asian countries, the aim of the present study was to determine the most common causes of primary and secondary amenorrhea in korean women on a large scale. Secondary amenorrhea is defined as the absence of menstruation for at least three cycles or at least 6 months in females who have already established menstruation.
A pregnancy test is a common first step for diagnosis. This chapter considers the various causes of amenorrhea and their treatment. Evaluation of amenorrhea, anovulation, and abnormal bleeding. This fact sheet focuses on secondary amenorrhea that is not. Pcos causes relatively high and sustained levels of hormones, rather than the fluctuating levels seen in the normal menstrual cycle. In a large case series of primary amenorrhea, the most common etiologies were 2. It is helpful to divide the evaluation of amenorrhea into three categories. In this case, the structures develop normally but fail to work properly, leading. Secondary amenorrhea occurs when a woman stops having periods for three or more months in a row after having regular periods in the past. Amenorrhea is the loss or lack of menstrual periods. Assessment secondary hcg fsh lh e2 prl tfts t, shbg, dhea, 17oh prog. Amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus.
Breastfeeding and menopause are also common, but natural, causes. It also considers the diagnosis and treatment of abnormal uterine bleeding at all stages of life. This fact sheet focuses on secondary amenorrhea that is not due to pregnancy. The differential diagnosis of secondary amenorrhea is broad and can. These triggers include weight loss, excessive exercise, and excessive stress meczekalski et al. Causes of primary and secondary amenorrhea health save blog. This can cause irregular or missed menstrual periods. The gynecologic age, the time in months since menarche, is the best indicator that a normal ovulatory pattern should have been established. In the absence of pregnancy, the challenge is to determine the exact etiology of amenorrhea. Rule out pregnancy a pregnancy test is recommended as a first step in evaluating any woman with secondary amenorrhea. Causes of secondary amenorrhea are related more to the function of the hpg axis rather than a physical abnormality.
For example, the most common cause of secondary amenorrhea is pregnancy. Secondary amenorrhea missing three menstrual periods in a row or not having periods for at least 6 months after menstruating normally can result from various causes. Although amenorrhea may result from a number of different conditions, a systematic evaluation including a detailed. Neuroendocrine causes of amenorrheaan update the journal. Hence, we investigated the prevalence of secondary amenorrhea among all females n 1099 that consulted in our clinic, grouped by age 1550 yrs, time months of amenorrea and identifying the. An overactive thyroid gland hyperthyroidism or underactive thyroid gland hypothyroidism can cause menstrual irregularities, including amenorrhea.
This chapter considers the various causes of amenorrhea and their. Secondary amenorrhea s most common and most easily diagnosable causes are pregnancy, thyroid disease, and hyperprolactinemia. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. Amenorrhea is the absence of menstrual bleeding in a woman of reproductive age.
Causes of secondary amenorrhoea in those with features of androgen excess such as hirsutism, acne and virilization include. Primary amenorrhea is usually the result of a genetic or anatomical abnormality. Further causes are varied and may include conditions that affect the ovaries, uterus, hypothalamus, or pituitary gland. Treatment of the underlying condition often resolves amenorrhea. Secondary amenorrhea is the absence of menses for three months in women with previously normal menstruation and for nine months in women with previous oligomenorrhea. Current evaluation of amenorrhea health science center. For example, a patient with complete androgen resistance would benefit from the involvement of experts in endocrinology, human genetics, psychiatry, and.
Androgen secreting tumours of the ovaries cause secondary amenorrhea. Details on treatments and causes of amenorrhea the absence of a monthly period are provided. Women who take birth control pills or who receive hormone shots such as depoprovera may not have any monthly bleeding. Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age.
Secondary amenorrhea occurs when you miss your period for six months or longer. The common causes are hypothalamic amenorrhea and outflow tract obstruction. The most common cause of secondary amenorrhea is pregnancy. Other physiologic causes include breastfeeding and menopause. If a teenager does not have a menstrual period by age 16, it is called primary amenorrhea. Primary amenorrhea is due to changes in organs, glands, and hormones related to menstruation. Androgensecreting tumours of the ovary or adrenal gland rare. Apr 27, 2020 amenorrhea is the absence of menstrual bleeding and may be primary or secondary primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics for example, breast development and pubic hair in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years. Primary amenorrhea this is when a girl over age 15.
However, all causes of secondary amenorrhea can also present as primary amenorrhea. Primary or secondary amenorrhea typically occurs in women with. The possible physiological causes of amenorrhea are. Oct 14, 2019 the causes of menstrual cycle disturbance leading to the development of amenorrhea are so diverse that in some complex cases, the situation is best addressed by a multidisciplinary team. Anatomic causes, including pregnancy, that almost always can be. Mar 14, 2014 these studies have been used as a reference regarding the causes of amenorrhea. Jan 15, 2018 amenorrhea not due to pregnancy, lactation, or menopause is a relatively common abnormality of the reproductive years and indicative of a defect somewhere in the hypothalamicpituitaryovarianuterine axis. Pregnancy is the most common natural cause of secondary amenorrhea. Epidemiology and causes of secondary amenorrhea uptodate. Pdf amenorrhea results when the orderly sloughing of the uterine lining on account of the interactions of hormones fails to occur. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. Secondary amenorrhea occurs when youve had at least one menstrual period and you stop menstruating for three months or longer. Medical causes of secondary amenorrhea may include pcos, hypothalamic dysfunction, pituitary disease, ovarian or uterine disorders, endocrinopathies. Describe the classification of amenorrhea and list the major causes of primary and secondary amenorrhea.
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