Possible causes include pregnancy, hormonal changes, or losing or gaining a lot of weight quickly. Amenorrhea in pregnancy is a normal physiological function. Secondary amenorrhea definition of secondary amenorrhea. There are primary and secondary causes of amenorrhea. This article discusses secondary amenorrhea and provides a systematic approach to its diagnostic evaluation, with referral considerations. Secondary amenorrhoea is defined as the cessation of menstruation for six consecutive months in a woman who has previously regular periods.
Amenorrhoea is the absence or cessation of menstruation. Image 1a t1 weighted, 1b and 1c t2 weighted magnetic resonance imaging. Pdf most of the documents on the racgp website are in portable document format pdf. Secondary amenorrhea secondary amenorrhea is the absence of menstrual periods for 6 months in a woman who had previously been regular, or for 12 months in a woman who had irregular periods without any physiological reasons. Treatment can range from behavior modification for excessive exercise to medication to surgery. Secondary and primary amenorrhea definition, causes, treatment. Secondary amenorrhea occurs in women who have had normal menstrual cycles that have stopped for six months or more. Outside the reproductive years, there is absence of menses during childhood and after menopause. Weight loss the most important and probably most common cause of amenorrhea in adolescent girls is anorexia nervosa. There are two types of amenorrhea primary or secondary. Amenorrhea is characterized by a complete lack of menstrual cycles.
Started in 1995, this collection now contains 6769 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Oligomenorrhea is defined as menses occurring at intervals longer than 35 days. Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age. Amenorrhea is the loss or lack of menstrual periods. To open a pdf file you will need compatible software such as adobe reader. Secondary amenorrhea can occur due to natural changes in the body. The pathophysiology of amenorrhea in the adolescent neville h. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. The most common etiologies are pregnancy and polycystic ovarian syndrome pcos.
If a teenager does not have a menstrual period by age 16, it is called primary amenorrhea. Secondary amenorrhea is due to pregnancy, stress, illness or other causes. Evaluation and management of amenorrhea related to congenital. Disruptions in the menstrual cycle are a common complaint in primary care and womens health. There is a lesion seen within the pituitary gland centred to the right of the midline which is of high signal intensity on the t2 weighted imaging and shows slightly reduced signal intensity compared with adjacent pituitary on the t1. Further, high levels of prolactin stimulated by an overactive anterior pituitary gland or by a pituitary tumor can produce secondary amenorrhea. Amenorrhoea cause primary % secondary % hypothalamic 20 35. Breastfeeding and menopause are also common, but natural, causes. Up to 50% of competitive runners training 80 miles per week and up to 44% of ballet dancers have amenorrhea. The cessation of menstruation for abnormal reasons. Is defined as the cessation of menstruation for six consecutive months in a woman who has previously regular periods.
A woman aged 26 with infertility, secondary amenorrhea and low levels of gonadotropin was referred to us as a case of hypothalamic amenorrhea. No consensus has been reached regarding the point at which oligomenorrhea becomes amenorrhea. There was a mass measuring 56 x 41 mm in her right. Causes include anorexia nervosa, disease of the female reproductive tract, and overexercise. Details on treatments and causes of amenorrhea the absence of a monthly period are provided. The most common cause of amenorrhea is pregnancy and it. A young woman with yellow hands and secondary amenorrhoea. Secondary amenorrhea is a condition when period cycle of women with irregular menstruation disappeared within six months in a row or. Secondary amenorrhea occurs when youve had at least one menstrual period and you stop menstruating for three months or longer. Secondary amenorrhea testing indications for testing amenorrhea with negative pregnancy test order prolactin luteinizing hormone and follicle stimulating hormone. Secondary amenorrhea occurs when a woman stops having periods for three or more months in a row after having regular periods in the past. Primary and secondary amenorrhea and precocious puberty. Secondary amenorrhea can also be caused by certain medications, notably the birth control medication medroxyprogesterone brand name.
Secondary amenorrhoea absence of menses for more than three cycles or 6 months in women who previously had menses. Secondary amenorrhoea cause % ovarian 40 hypothalamic 35 pituitary 19 uterine 5 other 1. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Amenorrhea is defined as the absence or abnormal cessation of menstruation in women of reproductive age and can be divided into primary and secondary amenorrhea 1,2. Primary and secondary amenorrhea flashcards quizlet. Women who take birth control pills or who receive hormone shots such as depoprovera may not have any monthly bleeding. Amenorrhea from these disorders, to some extent, is. Definition when menstruation has previously occurred but it has stopped for at least 6 consecutive months consider the cause of the amenorrhoea to guide appropriate referral eg endocrinology infertility or pcos service general gynae eating disorders service. Secondary amenorrhea is defined as the absence of menstrual flow in women with previously normal menstruation. Primary and secondary amenorrhea chapter pdf available. Secondary amenorrhea is defined as the cessation of regular menses for three months or the ces sation of irregular menses for six months. For example, the most common cause of secondary amenorrhea is pregnancy. Secondary amenorrhea testing algorithm arup consult. Even if you dont have periods, you could still get pregnant.
The pathophysiology of amenorrhea in the adolescent. Choose when to start an evaluation for secondary amenorrhea2. Many adult women are happy to forgo the inconvenience of a monthly period. However, patients with previously regular cycles are evaluated for secondary amenorrhea if menses have been absent for. List the most common causes of secondary amenorrhea in women of reproductive age estimated time. Amenorrhea in adolescents newbery pediatric medicine. Physicians should initiate antibiotic treatment in women with tb. Most of the causes of secondary amenorrhoea can also cause primary amenorrhoea if they occur before the menarche. Primary amenorrhoea is defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics such as breast development, or by years of age in girls with no. This may appear as primary amenorrhea, which is the lack of menstruation before age 16. They are usually causes of secondary amenorrhea but can cause primary amenorrhea. Genital tuberculosis tb destroys the endometrium thereby causing secondary amenorrhea. Epidemiology and causes of secondary amenorrhea uptodate. Amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina table 1 and table 2.
The causes of primary and secondary amenorrhea are quite vast, with significant overlap between the two categories. Pdf on oct 26, 2011, valentina chiavaroli and others published primary and secondary amenorrhea find, read and cite all the research you need on. Magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Most cases of secondary amenorrhea can be attributed to. Secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence of pregnancy, breastfeeding or menopause. Secondary amenorrhea is defined as the cessation of menses sometime after menarche has occurred. Secondary amenorrhea is present when a young woman ceases to menstruate after she has had one or more menstrual periods. Current evaluation of amenorrhea the practice committee of the american society for reproductive medicine birmingham, alabama amenorrhea is the absence or abnormal cessation of the menses. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she. Carlson division of adolescent medicine, stanford university school of medicine, mountain view, california, usa menstrual irregularity is a common occurrence during adolescence, especially within. Occasionally, the same underlying problem can cause or contribute to either primary or secondary amenorrhea. Possible causes include pregnancy, hormonal changes, and losing or gaining a lot of weight quickly. Amenorrhea is the absence of a menstrual period in a woman of reproductive age.
Extreme weight gain or loss, certain medications, as well as anxiety can be the root cause of amenorrhea. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation breastfeeding, the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method. It is often classified as either primary absence of menarche by age 15 years or secondary absence of menses for more than three months in girls or women who previously had regular. 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. Secondary amenorrhea means you have had periods, and then they stop, especially for more than 3 months. 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. In primary amenorrhea, menstrual periods have never begun by age 16, whereas secondary amenorrhea is defined as the absence of menstrual.
An initial secondary amenorrhea workup includes thyroid stimulating hormone tsh, prolactin, follicle stimulating hormone fsh, and luteinizing hormone lh tests. For example, hypothalamic problems, anorexia or extreme exercise can play a major role in causing amenorrhea depending on the persons age and if she has experienced menarche. These files will have pdf in brackets along with the filesize of the download. Amenorrhea is the medical term for the absence of menstrual periods, either over a permanent or temporary basis. Some authors suggest the absence of menses for 6 months constitutes. It is often classified as either primary absence of menarche by age 15 years or thereafter or secondary absence of menses for more than three months in girls or women who previously.
Learning objectives and cmedisclosure information this activity is intended for healthcare providers delivering care to women and their families. Causes of primary and secondary amenorrhea health save blog. Primary amenorrhea is due to changes in organs, glands, and hormones related to menstruation. Primary and secondary amenorrhea describes the occurrence of amenorrhea before and after menarche.
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