Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who havent begun menstruation by age 15. See epidemiology and causes of secondary amenorrhea and evaluation and management of. Secondary amenorrhea district i acog medical student education module 2011 definitions amenorrhea. The following medical conditions are some of the possible causes of secondary amenorrhea. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. Treatment options differ for both primary and secondary amenorrhea. An initial secondary amenorrhea workup includes thyroid stimulating hormone tsh, prolactin, follicle stimulating hormone fsh, and luteinizing hormone. 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. Even if you dont have periods, you could still get pregnant. Up to 50% of competitive runners training 80 miles per week and up to 44% of ballet dancers have amenorrhea. Androgen secreting tumours of the ovaries cause secondary amenorrhea. Secondary amenorrhea can occur due to natural changes in the body.
The most common cause in adolescents is hypothalamic. In a large case series of primary amenorrhea, the most common etiologies were 2. In some cases, contraceptive pills or other hormone therapies can restart your menstrual cycles. Treatment goals for patients with amenorrhea may vary considerably, and depend. Primary or secondary amenorrhea typically occurs in women with. Although amenorrhea may result from a number of different conditions, a systematic evaluation including a. In many cases, the cause of primary amenorrhea is not known. This fact sheet focuses on secondary amenorrhea that is not due to pregnancy.
Secondary amenorrhoea cause % ovarian 40 hypothalamic 35 pituitary 19 uterine 5 other 1. It also considers the diagnosis and treatment of abnormal uterine bleeding at all. The gynecologic age, the time in months since menarche, is the best indicator that a normal ovulatory pattern should have been established. This chapter considers the various causes of amenorrhea and their treatment. Other causes of amenorrhea include problems with the reproductive organs or with the glands that help regulate hormone levels. Physiological causes of amenorrhea functional hypothalamic amenorrhea fha fha, or stressinduced anovulation, is one of the most common causes of secondary amenorrhea, and it accounts for the reproductive dysfunction seen in undernutrition, excessive exercise, severe emotional stress, and chronic disease. In order to exclude organic diseases of the hypothalamic area, including but not limited to. An understanding of the neuroendocrine causes of amenorrhea and infertility is therefore critical when evaluating patients presenting with these complaints in order to implement the most appropriate treatment regimen. Primary amenorrhea, in which menstruation does not occur by age 15.
Secondary amenorrhea occurs when you miss your period for six months or longer. Women who take birth control pills or who receive hormone shots such as depoprovera may not have any monthly bleeding. Amenorrhea is the absence or abnormal cessation of the menses 1. Stress, malnutrition, and exercise can all cause amenorrhea in adults. Evaluation and management of secondary amenorrhea uptodate. 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. Evaluation of amenorrhea, anovulation, and abnormal. It also considers the diagnosis and treatment of abnormal uterine bleeding at all stages of life. The most common cause of secondary amenorrhea is pregnancy. Prolactin levels should be checked in most patients. Elicit a pertinent history to evaluate amenorrhea and list the essential elements of a focused physical.
Find out what are causes of primary secondary amenorrhea, clinical features, and management. Secondary amenorrhea is due to pregnancy, stress, illness or other causes. Treatment of the underlying condition often resolves amenorrhea. Secondary amenorrhea american academy of pediatrics. Gonadal dysgenesis, including turner syndrome 43 percent. It may be a sign of underdeveloped or malfunctioning ovaries. In these conditions, products of menstruation accumulate behind the defect and can lead to cyclic or acute pelvic pain. Carlson division of adolescent medicine, stanford university school of medicine, mountain view, california, usa menstrual irregularity is a common occurrence during adolescence, especially within the. In an adolescent, amenorrhea can be a sign of a medical problem or a side effect of certain medications. Amenorrhea in adults causes and management medical. Medical causes of secondary amenorrhea may include pcos, hypothalamic dysfunction, pituitary disease, ovarian or uterine disorders, endocrinopathies. Secondary amenorrhea develops when a female with normal menstrual cycle stops having her periods for more than six months 2.
There are two types of amenorrhea primary or secondary. The pathophysiology of amenorrhea in the adolescent. A simple discussion of these causes with additional information is below. This section discusses 26 medical conditions causing secondary amenorrhea. Secondary amenorrhea means you have had periods, and then they stop, especially for more than 3 months. Medical causes of secondary amenorrhea may include pcos, hypothalamic dysfunction, pituitary disease, ovarian or uterine disorders, endocrinopathies, pregnancy. Disruptions in the menstrual cycle are a common complaint in primary care and womens health. This article discusses secondary amenorrhea and provides a systematic approach to its diagnostic evaluation, with referral considerations.
A woman whos had her uterus or ovaries taken out will also stop menstruating. 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. Secondary amenorrhea this is when a woman who has had regular periods stops having her period for six months or longer. Hypothalamus pituitary ovary uterus cervix vagina involved structurally in the outflow of menstrual blood involved in endocrine regulation of the menstrual cycle. Rule out pregnancy a pregnancy test is recommended as a first step in evaluating any woman with secondary amenorrhea. These causes of amenorrhea are the most commonly encountered in adults. The majority of the causes of primary and secondary. Although amenorrhea may result from a number of different conditions, a systematic evaluation including a detailed. Secondary amenorrhea refers to cessation of menses after menarche. If a tumor or structural blockage is causing the problem, surgery may be necessary. Assessment secondary hcg fsh lh e2 prl tfts t, shbg, dhea, 17oh prog.
Hormonal birth control can also contribute to secondary amenorrhea. Depoprovera, a hormonal birth control shot, and hormonal birth control pills, may cause you to miss menstrual periods. Natural changes in the body can cause your periods. Irregular or absent menstrual periods should trigger an evaluation to identify the root cause. Pregnancy is the most common natural cause of secondary amenorrhea. Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age. Secondary cont if prl elevated drug history repeat. Timing of the evaluation of primary amenorrhea recognizes the trend to earlier age at. Details on treatments and causes of amenorrhea the absence of a monthly period are provided. Secondary amenorrhea develops when a female with normal menstrual cycle stops having her periods for more than six months. Primary and secondary amenorrhea flashcards quizlet. Neuroendocrine causes of amenorrheaan update the journal. Amenorrhea is a menstrual condition characterized by absent menstrual periods for more than three monthly menstrual cycles. For example, the most common cause of secondary amenorrhea is pregnancy.
Secondary and primary amenorrhea definition, causes, treatment. There are likely to be other possible causes, so ask your doctor about your. The most common etiologies are pregnancy and polycystic ovarian syndrome pcos. Other physiologic causes include breastfeeding and menopause. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. Extreme weight gain or loss, certain medications, as well as anxiety can be the root cause of amenorrhea. The pathophysiology of amenorrhea in the adolescent neville h. Jan 12, 2015 over 50% of cases of secondary amenorrhea result from perturbations in the hypothalamicpituitaryadrenal hpa axis. However, it must be noted that women who are pregnant, breastfeeding or those who are in menopause are not considered to. Magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Secondary amenorrhea is defined as the absence of menstrual flow in women with previously normal menstruation.
Other forms of primary and secondary amenorrhea should be distinguished from fha, including genetic causes such as kallman syndrome and praderwilli syndrome caronia et al. Amenorrhea is a condition characterized by complete stoppage or missing of menstrual periods 1. For instance, primary amenorrhea can result from structural problems with your sex organs. 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. The epidemiology and causes of secondary amenorrhea and overviews of primary amenorrhea and abnormal uterine bleeding in adolescents are discussed separately. Secondary amenorrhea north dakota department of health. It also considers the diagnosis and treatment of abnormal uterine. Possible causes include pregnancy, hormonal changes, and losing or gaining a lot of weight quickly. Jul 25, 2019 treatment depends on the underlying cause of your amenorrhea. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Nov 30, 2015 magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Endocrine causes secondary amenorrhea etiology thyroid disorder and cushings disease interfere with the normal functioning of the hypothalamic pituitary ovarian axis present with amenorrhea.
Treating secondary amenorrhea generally varies depending on the underlying cause of. An absence of menstruation for at least half a year or three consecutive periods in women who had normal menstrual periods before this is termed secondary amenorrhea. Breastfeeding and menopause are also common, but natural, causes. Young athletes are particularly vulnerable, although normal menses usually return with healthy body weight. Causes of primary and secondary amenorrhea health save blog. Over 50% of cases of secondary amenorrhea result from perturbations in the hypothalamicpituitaryadrenal hpa axis. Causes of secondary amenorrhea can also result in primary amenorrhea, especially if present before onset of menarche. After pregnancy is ruled out, the initial workup should be based on patient history and physical examination findings. Amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus. Apr 19, 2018 secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence of pregnancy, breastfeeding or menopause.
We go over the definition of amenorrhea, causes, and. Missing several menstrual periods in a row is the primary symptom of secondary amenorrhea. Jun 04, 2019 amenorrhea is a condition characterized by complete stoppage or missing of menstrual periods 1. 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. The majority of the causes of primary and secondary amenorrhea are similar. 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. Primary amenorrhea refers to failure to achieve menarche by age 16. Secondary amenorrhea in women of reproductive age may be an indication of an undiagnosed, chronic condition and appropriate treatment is. Primary amenorrhea is usually the result of a genetic or anatomical abnormality. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications.
Evaluation of amenorrhea, anovulation, and abnormal bleeding. In this kind of amenorrhea, normal during lactation or pregnancy a womans periods commence and then cease to occur. Although clinically the criteria for amenorrhea is absence of menses for 6 months or for 3 times the length of the previous menstrual cycle, 43 in research a definition of no menses for 90 days is most commonly. Amenorrhea is the medical term for the absence of menstrual periods, either over a permanent or temporary basis. Whereas primary amenorrhea is defined as a lack of menses in a woman who had never previously menstruated, secondary amenorrhea is. 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. However, all causes of secondary amenorrhea can also present as primary amenorrhea. Anorexia nervosa is a condition that is characterized by severe malnutrition due to a food disorder and can be associated with amenorrhea. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had. Pdf amenorrhea results when the orderly sloughing of the uterine lining on account of the interactions of hormones fails to occur. Amenorrhea is defined as absence of menstrual periods.
Mar 30, 2019 common causes of secondary amenorrhea when a woman who has had normal periods stops getting them include. The most common cause of amenorrhea in women of childbearing age is pregnancy and lactation. Some birth control methods, such as depoprovera or certain types of intrauterine devices iuds stress. Secondary amenorrhea testing algorithm arup consult. These hormones cause the uterus to build a lining and the ovary to release an egg ovulation. Epidemiology and causes of secondary amenorrhea uptodate. Most common cause of secondary amenorrhea rule out with a urine or serum hcg before proceeding consider each level of the control of the menstrual cycle. Primary amenorrhea is due to changes in organs, glands, and hormones related to menstruation. 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. Figure 2,6 is an algorithm for the evalu ation of secondary amenorrhea. Learn vocabulary, terms, and more with flashcards, games, and other study tools. A hormonal imbalance is the most common cause of secondary amenorrhea.
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