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{{Amenorrhea}}
{{Amenorrhea}}


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==Overview==
==Overview==
The hallmark of primary amenorrhea is absence of [[menarche]] until 15 years of age, in the presence of other [[secondary sexual characteristics]]; or lack of [[menarche]] after 5 years of [[thelarche]], if [[thelarche]] occurred before 10 years of age. The hallmark of secondary amenorrhea is [[menstrual cycle]] interruption for at least 3 months, however were regular before; or [[menstrual cycle]] interruption for at least 6 months, however were irregular before.


==History==
==History and Symptoms==
 
*The hallmark of primary amenorrhea is:
==Symptoms==
**Absence of [[menarche]] until 15 years of age, in the presence of other [[secondary sexual characteristics]].
Symptoms of amenorhea include:
**Absence of [[menarche]] after 5 years of [[thelarche]], if [[thelarche]] occurred before 10 years of age.<ref name="Herman-GiddensSlora1997">{{cite journal|last1=Herman-Giddens|first1=M. E.|last2=Slora|first2=E. J.|last3=Wasserman|first3=R. C.|last4=Bourdony|first4=C. J.|last5=Bhapkar|first5=M. V.|last6=Koch|first6=G. G.|last7=Hasemeier|first7=C. M.|title=Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network|journal=PEDIATRICS|volume=99|issue=4|year=1997|pages=505–512|issn=0031-4005|doi=10.1542/peds.99.4.505}}</ref>


* [[Weight gain]]
* The hallmark of secondary amenorrhea is:
* [[Headache]]
** [[Menstrual cycle]] is interrupted for at least 3 months, however were regular before.<ref name="ChiavaroliDAdamo2011">{{cite journal|last1=Chiavaroli|first1=Valentina|last2=DAdamo|first2=Ebe|last3=Diesse|first3=Laura|last4=de|first4=Tommaso|last5=Chiarelli|first5=Francesco|last6=Moh|first6=Angelika|title=Primary and Secondary Amenorrhea|year=2011|doi=10.5772/17675}}</ref>
* Milky nipple discharge
** [[Menstrual cycle]] is interrupted for at least 6 months, however were irregular before.<ref>{{cite book | last = Fritz | first = Marc | title = Clinical gynecologic endocrinology and infertility | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2011 | isbn = 978-0781779685 }}</ref>
* Vision problems
<br>
* [[Hirsutism]]
<div style="text-align: center;">'''Patients history and symptoms that are suggestive of different causes of amenorrhea are as following table:'''<ref name="pmid23939500">{{cite journal |vauthors=Klein DA, Poth MA |title=Amenorrhea: an approach to diagnosis and management |journal=Am Fam Physician |volume=87 |issue=11 |pages=781–8 |year=2013 |pmid=23939500 |doi= |url=}}</ref><ref name="pmid16669559">{{cite journal |vauthors=Master-Hunter T, Heiman DL |title=Amenorrhea: evaluation and treatment |journal=Am Fam Physician |volume=73 |issue=8 |pages=1374–82 |year=2006 |pmid=16669559 |doi= |url=}}</ref></div>
* [[Acne]]
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Groups
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Elements
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Underlying cause of amenorrhea
|-
| rowspan="23" style="background:#DCDCDC;" align="center" + |'''Patient history'''
| colspan="2" |'''[[Stress]]'''
| rowspan="11" |Functional amenorrhea
|-
| colspan="2" |'''[[Exercise]]'''
|-
| colspan="2" |'''[[Weight loss]]'''
|-
| rowspan="4" |'''Chronic [[illness]]'''
|[[Crohn disease]]
|-
|[[Cystic fibrosis]]
|-
|[[Sickle cell disease]]
|-
|[[Thalassemia major]]
|-
| rowspan="4" |'''[[Drug use|Illicit drug use]]'''
|[[Alcohol]]
|-
|[[Cocaine]]
|-
|[[Marijuana]]
|-
|[[Opioids]]
|-
| colspan="2" |'''Lack of [[menarche]]'''
|Primary amenorrhea
|-
| colspan="2" |'''[[Menstrual cycle|Menstrual]] history'''
|Secondary amenorrhea
|-
| colspan="1" rowspan="4" |'''[[Prescription]] drug use'''
|[[Androgens]]
| rowspan="4" |Multiple, depending on [[medication]]
|-
|[[Antidepressants]]
|-
|[[Danazol]]
|-
|High-dose [[progestins]]
|-
| colspan="2" rowspan="1" |'''Previous [[central nervous system]] [[chemotherapy]] or [[radiation]]'''
| colspan="1" rowspan="1" |[[Hypothalamic]] amenorrhea
|-
| colspan="2" rowspan="1" |'''Previous [[pelvic]] [[radiation]]'''
| colspan="1" rowspan="1" |[[Premature ovarian failure]]
|-
| colspan="2" rowspan="1" |'''[[Psychosocial]] stressors'''
| colspan="1" rowspan="3" |[[Anorexia]] or [[bulimia nervosa]]
|-
| colspan="2" |'''[[Nutritional]] problems'''
|-
| colspan="2" |'''[[Exercise]] history'''
|-
| colspan="2" rowspan="1" |'''[[Sexual activity]]'''
| colspan="1" rowspan="1" |[[Pregnancy]]
|-
| rowspan="10" style="background:#DCDCDC;" align="center" + |'''Family history'''
| colspan="1" rowspan="6" |'''[[Genetic defects]]'''
|Congenital [[gonadotropin-releasing hormone]] deficiency
| colspan="1" rowspan="6" |Multiple causes of primary amenorrhea
|-
|[[GnRH]] receptor [[gene]] mutations
|-
|[[Prader-Willi syndrome]]
|-
|Congenital [[Thymus|thymic]] [[aplasia]]
|-
|[[Fragile X syndrome]]
|-
|Idiopathic accelerated [[ovarian]] [[follicular atresia]]
|-
| colspan="2" rowspan="1" |'''[[Pubic hair]] pattern'''
| colspan="1" rowspan="1" |[[Androgen insensitivity syndrome]]
|-
| colspan="2" rowspan="1" |'''[[Infertility]]'''
|Multiple causes of primary amenorrhea
|-
| colspan="2" rowspan="1" |'''[[Menarche]] and [[menstrual]] history (mother and sisters)'''
| colspan="1" rowspan="1" |[[Constitutional delay of puberty|Constitutional delay of growth and puberty]]
|-
| colspan="2" rowspan="1" |'''[[Pubertal]] history (e.g., [[growth delay]])'''
| colspan="1" rowspan="1" |[[Constitutional delay of puberty|Constitutional delay of growth and puberty]]
|-
| rowspan="16" style="background:#DCDCDC;" align="center" + |'''Review of systems'''
| colspan="2" rowspan="1" |'''[[Anosmia]]'''
| colspan="1" rowspan="1" |[[Kallmann syndrome]]
|-
| colspan="2" rowspan="1" |'''Cyclic [[abdominal pain]]'''
| colspan="1" rowspan="2" |Outflow tract obstruction or [[müllerian agenesis]]
|-
| colspan="2" |'''[[Breast]] changes'''
|-
| colspan="2" rowspan="1" |'''[[Galactorrhea]]'''
| colspan="1" rowspan="3" |[[Pituitary tumor]]
|-
| colspan="2" |'''[[Headache]]'''
|-
| colspan="2" |'''[[Visual impairment|Visual disturbances]]'''
|-
| colspan="2" rowspan="1" |'''[[Hirsutism]]'''
| colspan="1" rowspan="2" |[[Polycystic ovary syndrome]]
|-
| colspan="2" |'''[[Acne]]'''
|-
| rowspan="7" |'''Signs and symptoms of [[hypothyroidism]] or [[hyperthyroidism]]'''
|[[Temperature]] intolerance
| colspan="1" rowspan="7" |[[Thyroid disease]]
|-
|[[Palpitations]]
|-
|[[Diarrhea]]
|-
|[[Constipation]]
|-
|[[Tremor]]
|-
|[[Depression]]
|-
|[[Skin changes]]
|-
| colspan="2" rowspan="1" |'''[[Vasomotor]] symptoms'''
| colspan="1" rowspan="1" |[[Premature ovarian failure]]
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 20:22, 29 July 2020

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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

The hallmark of primary amenorrhea is absence of menarche until 15 years of age, in the presence of other secondary sexual characteristics; or lack of menarche after 5 years of thelarche, if thelarche occurred before 10 years of age. The hallmark of secondary amenorrhea is menstrual cycle interruption for at least 3 months, however were regular before; or menstrual cycle interruption for at least 6 months, however were irregular before.

History and Symptoms

  • The hallmark of secondary amenorrhea is:


Patients history and symptoms that are suggestive of different causes of amenorrhea are as following table:[4][5]
Groups Elements Underlying cause of amenorrhea
Patient history Stress Functional amenorrhea
Exercise
Weight loss
Chronic illness Crohn disease
Cystic fibrosis
Sickle cell disease
Thalassemia major
Illicit drug use Alcohol
Cocaine
Marijuana
Opioids
Lack of menarche Primary amenorrhea
Menstrual history Secondary amenorrhea
Prescription drug use Androgens Multiple, depending on medication
Antidepressants
Danazol
High-dose progestins
Previous central nervous system chemotherapy or radiation Hypothalamic amenorrhea
Previous pelvic radiation Premature ovarian failure
Psychosocial stressors Anorexia or bulimia nervosa
Nutritional problems
Exercise history
Sexual activity Pregnancy
Family history Genetic defects Congenital gonadotropin-releasing hormone deficiency Multiple causes of primary amenorrhea
GnRH receptor gene mutations
Prader-Willi syndrome
Congenital thymic aplasia
Fragile X syndrome
Idiopathic accelerated ovarian follicular atresia
Pubic hair pattern Androgen insensitivity syndrome
Infertility Multiple causes of primary amenorrhea
Menarche and menstrual history (mother and sisters) Constitutional delay of growth and puberty
Pubertal history (e.g., growth delay) Constitutional delay of growth and puberty
Review of systems Anosmia Kallmann syndrome
Cyclic abdominal pain Outflow tract obstruction or müllerian agenesis
Breast changes
Galactorrhea Pituitary tumor
Headache
Visual disturbances
Hirsutism Polycystic ovary syndrome
Acne
Signs and symptoms of hypothyroidism or hyperthyroidism Temperature intolerance Thyroid disease
Palpitations
Diarrhea
Constipation
Tremor
Depression
Skin changes
Vasomotor symptoms Premature ovarian failure

References

  1. ↑ Herman-Giddens, M. E.; Slora, E. J.; Wasserman, R. C.; Bourdony, C. J.; Bhapkar, M. V.; Koch, G. G.; Hasemeier, C. M. (1997). "Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network". PEDIATRICS. 99 (4): 505–512. doi:10.1542/peds.99.4.505. ISSN 0031-4005.
  2. ↑ Chiavaroli, Valentina; DAdamo, Ebe; Diesse, Laura; de, Tommaso; Chiarelli, Francesco; Moh, Angelika (2011). "Primary and Secondary Amenorrhea". doi:10.5772/17675.
  3. ↑ Fritz, Marc (2011). Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0781779685.
  4. ↑ Klein DA, Poth MA (2013). "Amenorrhea: an approach to diagnosis and management". Am Fam Physician. 87 (11): 781–8. PMID 23939500.
  5. ↑ Master-Hunter T, Heiman DL (2006). "Amenorrhea: evaluation and treatment". Am Fam Physician. 73 (8): 1374–82. PMID 16669559.

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