Amenorrhea classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Amenorrhea can be classified on the basis of etiology into three subtypes, including primary amenorrhea, secondary amenorrhea, and functional amenorrhea. Primary amenorrhea can also be classified on the basis of HPG (hypothalamic-pituitary-gonadal) axis function into hypergonadotropic hypogonadism, hypogonadotropic hypogonadism, and eugonadotropic state. Secondary amenorrhea reflects an absence of menstrual cycle for at least 3 months in a woman with normal menstruation cycles in the past. Secondary amenorrhea can be classified based on pathology into polycystic ovary syndrome, hypothalamic-pituitary dysfunction, hypothalamic-pituitary failure, and ovarian failure. Functional (hypothalamic) amenorrhea is a subtype of the amenorrhea seen in patients with erratic lifestyle and can be classified on the basis of etiology into stress, weight loss, and exercise related amenorrhea.
Classification
- Amenorrhea may be classified according to etiology into three subtypes:
- Primary amenorrhea
- Secondary amenorrhea
- Functional amenorrhea
- Each of the subtypes of amenorrhea has their own classifications, as following:
| Amenorrhea classification | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lifestyle etiology | Lack of menarche | Mensturation absence more than 3 months | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Functional amenorrhea | Secondary amenorrhea | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stress related | Weight loss related | Exercise related | Polycystic ovary syndrome | Hypothalamic-pituitary dysfunction | Hypothalamic-pituitary failure | Ovarian failure | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Primary amenorrhea | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Present uterus | Absent uterus | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypergonadotropic hypogonadism | Hypogonadotropic hypogonadism | Eugonadotropic | Mullerian agenesis | Androgen insensitivity | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Primary amenorrhea
- Primary amenorrhea refers to an adolescent girl who have never experienced menarche. Primary amenorrhea is defined as one of the followings:[1][2][3]
- Normal secondary sexual characteristics and absence of menarche by 15 years of age.
- Lack of secondary sexual characteristics and absence of menarche by 14 years of age.
- Lack of menarche five years after initial breast development (thelarche).
- An important aspect of classification in patients with primary amenorrhea is the presence or absence of uterus.
- If uterus is present, primary amenorrhea can be classified based on plasma level of follicle stimulating hormone (FSH) and luteinizing hormone (LH), into hypergonadotropic hypogonadism (elevated FSH and LH), hypogonadotropic hypogonadism (decreased FSH and LH), and eugonadotropic state (normal FSH and LH).
- Patients with absent uterus can be classified into mullerian agenesis or androgen insensitivity.
Secondary amenorrhea
- Secondary amenorrhea is more common than primary amenorrhea. Secondary amenorrhea is defined as one of the followings:
- Absence of menstrual cycle for at least 3 months in a woman with normal menstrual cycle in the past.
- Absence of menstrual cycle for at least 9 months in a woman with a history of oligomenorrhea.
- Secondary amenorrhea can be classified based on pathology into polycystic ovary syndrome, hypothalamic-pituitary dysfunction, hypothalamic-pituitary failure, and ovarian failure.[1][4][5]
Functional amenorrhea
- Functional (hypothalmic) amenorrhea is a subtype of the amenorrhea seen in patients with erratic lifestyle and can be classified on the basis of etiology into stress, weight loss, and exercise related amenorrhea.[6]
- Functional amenorrhea is defined as absence of menstrual cycle for 6 months from disturbances in hypothalamic-pituitary-ovarian axis, and without any anatomical or organic pathology.[7]
- Generally, the primary factor that causes functional amenorrhea is lack of gonadotropin releasing hormone (GnRH) pulsatility.[8]
References
- ↑ 1.0 1.1 "Current evaluation of amenorrhea". Fertil. Steril. 90 (5 Suppl): S219–25. 2008. doi:10.1016/j.fertnstert.2008.08.038. PMID 19007635.
- ↑ Fritz, Marc (2011). Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9780781779685.
- ↑ Euling SY, Herman-Giddens ME, Lee PA, Selevan SG, Juul A, Sørensen TI, Dunkel L, Himes JH, Teilmann G, Swan SH (2008). "Examination of US puberty-timing data from 1940 to 1994 for secular trends: panel findings". Pediatrics. 121 Suppl 3: S172–91. doi:10.1542/peds.2007-1813D. PMID 18245511.
- ↑ Reindollar, Richard H.; Novak, Michael; Tho, Sandra P.T.; McDonough, Paul G. (1986). "Adult-onset amenorrhea: A study of 262 patients". American Journal of Obstetrics and Gynecology. 155 (3): 531–541. doi:10.1016/0002-9378(86)90274-7. ISSN 0002-9378.
- ↑ Reindollar RH, Byrd JR, McDonough PG (1981). "Delayed sexual development: a study of 252 patients". Am. J. Obstet. Gynecol. 140 (4): 371–80. PMID 7246652.
- ↑ Meczekalski B, Podfigurna-Stopa A, Warenik-Szymankiewicz A, Genazzani AR (2008). "Functional hypothalamic amenorrhea: current view on neuroendocrine aberrations". Gynecol. Endocrinol. 24 (1): 4–11. doi:10.1080/09513590701807381. PMID 18224538.
- ↑ Liu JH, Bill AH (2008). "Stress-associated or functional hypothalamic amenorrhea in the adolescent". Ann. N. Y. Acad. Sci. 1135: 179–84. doi:10.1196/annals.1429.027. PMID 18574223.
- ↑ Gordon, Catherine M. (2010). "Functional Hypothalamic Amenorrhea". New England Journal of Medicine. 363 (4): 365–371. doi:10.1056/NEJMcp0912024. ISSN 0028-4793.