Amenorrhea causes: Difference between revisions

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{{Amenorrhea}}
{{Amenorrhea}}


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{{CMG}}; {{AE}}{{EG}}, {{KS}}


{{CMG}}
==Overview==
Common causes of amenorrhea are [[breastfeeding]], [[pregnancy]], [[menopause]], and [[stress]]. Common causes of primary amenorrhea are [[craniopharyngioma]], [[idiopathic gonadotropin deficiency]], [[Kallmann's Syndrome]], [[Mayer-Rokitansky-Hauser Syndrome]], [[Mullerian dysgenesis]], and outflow tract disorders. Common causes of secondary amenorrhea are craniocerebral [[trauma]], [[curettage]], [[Cushing's Syndrome]], [[depression]], [[diabetes mellitus]], and drug side effects. Common causes of functional [[amenorrhea]] are [[stress]], rapid [[weight loss]], and excessive [[exercise]].
==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent [[disability]] within 24 hours if left untreated. There are no life-threatening causes of amenorrhea, however complications resulting from untreated amenorrhea are common.
 
===Common Causes===
* [[Breastfeeding]]
* [[Menopause]]
* [[Pregnancy]]
* [[Stress]]
* [[Turner syndrome]]
* Excessive [[exercise]]
* [[Dieting]]
* [[Obesity]]
* [[Hyperthyroidism]]
* [[Hypothyroidism]]
 
===Less Common Causes===
* [[Androgen insensitivity syndrome]] ([[testicular feminization]])
* [[Autoimmune disorders]]
** [[Autoimmune]] [[oophoritis]] (in [[myasthenia gravis]], [[thyroiditis]], or [[vitiligo]])
* [[Aneurysms]] of the [[pituitary]]
* [[Cachexia]]
 
* Chronic disorders
** [[Crohn disease]]
** [[Cystic fibrosis]]
** [[Sickle cell disease]]
** [[Thalassemia major]]
* [[Chemotherapy]] (e.g., high-dose [[Alkylating agent|alkylating drugs]])
 
* Congenital [[adrenal]] [[virilism]]
* [[Cushing syndrome]]
* [[Drug abuse]]
** [[Alcohol]]
** [[Cocaine]]
** [[Marijuana]]
** [[Opioids]]
 
* Drug-induced [[virilization]]
** [[Androgens]]
** [[Antidepressants]]
** [[Danazol]]
** High-dose [[progestins]]
* [[Eating disorders]]
** [[Anorexia nervosa]]
** [[Bulimia]]
 
* [[Genetic disorder]]
** Congenital [[gonadotropin-releasing hormone]] deficiency
** [[GnRH]] receptor [[gene]] mutations
** [[Prader-Willi syndrome]]
** Congenital [[Thymus|thymic]] [[aplasia]]
** [[Fragile X syndrome]]
** Idiopathic accelerated [[ovarian]] [[follicular atresia]]
* [[Gestational trophoblastic disease]]
* [[Gonadal dysgenesis]]
* [[HIV infection]]
* [[Hyperprolactinemia]]
* [[Idiopathic hypogonadotropic hypogonadism]]
* Infiltrative disorders of the [[pituitary]]
** [[Hemochromatosis]]
** [[Langerhans cell granulomatosis]]
** [[Sarcoidosis]]
** [[TB]]
 
* Isolated [[gonadotropin]] deficiency
* [[Immunodeficiency]]
* Infiltrative disorders of the [[hypothalamus]]
** [[Langerhans cell granulomatosis]]
** [[Lymphoma]]
** [[Sarcoidosis]]
** [[TB|Tuberculosis (TB)]]
* [[Irradiation]] to the [[pelvis]]
* [[Irradiation]] to the [[hypothalamus]]
 
* [[Kallmann syndrome]]
* [[Malnutrition]]
* [[Metabolic disorders]]
** [[Addison disease]]
** [[Diabetes mellitus]]
** [[Galactosemia]]
* [[Psychiatric disorders]]
** [[Stress]]
** [[Depression]]
** [[Obsessive-compulsive disorder]]
** [[Schizophrenia]]
** [[Psychoactive drugs]]
 
* [[Sheehan's syndrome|Postpartum pituitary necrosis (Sheehan syndrome)]]
* [[Tumors]] of the [[brain]]
** [[Meningioma]]
** [[Craniopharyngioma]]
** [[Gliomas]]
** [[Pituitary microadenoma]]
 
* [[Traumatic brain injury]]
* [[Tumors]] of the [[hypothalamus]]
* [[True hermaphroditism]]
 
* Tumors producing [[androgens]] ([[ovarian]] or [[adrenal]])


==Overview==
* [[Viral infections]] ([[mumps]])
 
===Causes by Organ System===
 
{| style="width: 80%; height: 100px; text-align: justify; text-justify: distribute;" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | [[Haemosiderosis]], [[heart disease]]
|-
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
| bgcolor="Beige" |[[Alcoholism]], [[Alcohol poisoning|Alcohol poisoning]], [[Lead poisoning|Lead poisoning]], [[Mercury poisoning|Mercury poisoning]], [[Morphine|Morphine poisoning]]
|-
|- bgcolor="LightSteelBlue"
| '''Dental'''
| bgcolor="Beige" |No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| bgcolor="Beige" |[[Systemic lupus erythematosus]]
|-
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| bgcolor="Beige" |[[Antidepressants]], [[Antipsychotics]], [[Chemotherapy]], [[Combined oral contraceptive pill]], [[Cyclophosphamide]], [[Epirubicin]], [[Ethanol]], [[Fluoxymesterone]], [[Medroxyprogesterone acetate|Medroxy-progesterone acetate]], [[Metoclopramide]], [[Nandrolone]], [[Spironolactone]], [[Stanozolol]]
|-
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| bgcolor="Beige" |[[ Acromegaly]], [[5-alpha-reductase deficiency]], [[Achard-Thiers syndrome]], [[Addison's disease]], [[Adrenal cortex cancer|Adrenal cortex tumours]], [[Adrenal gland disorders]], [[Adrenocortical hyperplasia]], Ahumada-Del Castillo syndrome, [[Androgen insensitivity syndrome]], [[Anorexia nervosa]], [[Anovulation]], [[Hypopituitarism|Anterior pituitary failure]], [[Arrhenoblastoma]], [[Autoimmune adrenalitis]], [[Breastfeeding]], [[C21-hydroxylase deficiency]], [[Chiari-Frommel syndrome]], [[Congenital adrenal hyperplasia ]], Conn syndrome, [[Constitutional delay of puberty]], [[Corpus luteum|Corpus luteum cyst]], [[Cortisone reductase deficiency]], [[Cretinism]], [[Cushing's disease]], [[Cushing syndrome]], [[Diabetes mellitus]], [[Dystrophia adipose-genitalis]], [[Eating disorders]], [[Empty sella syndrome]], [[Androgen|Exogenous androgen use]], [[Female athlete triad|Female athlete syndrome]], [[Forbes-Albright syndrome]], [[Frohlich's syndrome]], [[Follicle-stimulating hormone|FSH receptor deficiency]], [[Galactorrhea|Galactorrhea]], [[Galactorrhea|Galactorrhoea-hyperprolactinaemia]], [[GnRH|GnRH deficiency]], [[Hyperprolactinaemia]], [[Hyperthyroidism]], [[Hypogonadism]], [[Hypogonadotropic hypogonadism]], [[Hypopituitarism]], [[Hypothyroidism]], [[Incomplete androgen insensitivity]], [[Kallmann syndrome]], [[Laron syndrome ]], [[Virilization|Masculinization disorders]], [[Mayer-Rokitansky-Hauser syndrome|Mayer-Rokitansky syndrome]], [[Menopause]], [[Mullerian agenesis|Mullerian aplasia]], [[Mullerian dysgenesis|Mullerian dysgenesis]], [[Multiple endocrine neoplasia type 1]], [[Myxoedema]], [[Obesity]], [[Ovarian failure]], [[Ovarian insufficiency due to FSH resistance|Ovarian insufficiency due to FSH resistance]], [[Ovarian insufficiency, familial|Familial ovarian insufficiency]], [[Panhypopituitarism]], [[Menopause|Perimenopause]], [[Pituitary apoplexy]], [[Laron syndrome|Pituitary dwarfism]], [[Pituitary infarct]], [[Pituitary tumour]], [[Polycystic ovary syndrome]], [[Premature ovarian failure]], [[Prolactinoma]], Pseudoamenorrhea, [[Pseudocyesis]], [[Rapid weight loss]], [[Sheehan syndrome]], [[Simmonds' disease|Simmonds' disease]], [[Stein-Leventhal syndrome]], [[Testicular feminization syndrome]], [[Testosterone]], [[Thyrotoxicosis]], [[Underweight]], [[Weight gain]], [[Swyer's syndrome|XY female]]
|-
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| bgcolor="Beige" |Climate change
 
|-
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| bgcolor="Beige" |[[Anorexia nervosa]], [[Autoimmune hepatitis]], [[Bearn-Kunkel syndrome]], [[Celiac disease ]], [[Cystic fibrosis]], [[Eating disorders]], [[Hemosiderosis]], [[Hepatocellular carcinoma]], [[Inflammatory bowel disease]], [[Liver cirrhosis]], [[Malabsorption syndrome]], [[Rapid weight loss]], [[Weight gain]]
|-
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| bgcolor="Beige" |[[De Grouchy Syndrome|18p minus syndrome]], [[Vaginal agenesis|Agenesis of lower vagina]], [[Androgen insensitivity syndrome]], [[C21-hydroxylase deficiency]], [[Celiac disease]], [[Chromosome 15q trisomy|Chromosome 15q duplication syndrome]], Chromosome 17p - partial deletion, [[Cortisone reductase deficiency]], [[Swyer's syndrome|Defect in sry gene]], [[Cystic fibrosis]], [[Down's syndrome]], [[Fibroblast growth factor receptor 1|FGFR1 mutation]], [[Galactose-1-phosphate uridyltransferase deficiency]], [[Gonadal dysgenesis]], [[KAL1 gene|Kal1 mutation]], [[Kallmann syndrome]], [[Laurence-Moon-Biedl syndrome]], [[Mayer-Rokitansky-Hauser syndrome|Mayer-Rokitansky syndrome]], [[Premature ovarian failure|Ovarian insufficiency - familial]], [[Prader-Willi syndrome ]], [[Prokineticin receptor 2|PROKR2 mutation]], [[Tetrasomy X]], [[Triple X syndrome]], [[Turner syndrome]], [[Werner syndrome]], [[Swyer's syndrome|XY female]]
|-
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| bgcolor="Beige" |[[Anemia]], [[Hemosiderosis]], [[Hodgkin's disease]], [[Leukemia]] 
|-
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| bgcolor="Beige" |[[Antidepressants]], [[Antipsychotics]], [[Chemotherapy]], [[Combined oral contraceptive pill]], [[Cyclophosphamide]], [[Epirubicin]], [[Ethanol]], [[Fluoxymesterone]], [[Medroxyprogesterone acetate|Medroxy-progesterone acetate]], [[Metoclopramide]], [[Nandrolone]], [[Spironolactone]], [[Stanozolol]]
|-
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| bgcolor="Beige" |[[Mumps]], [[Tuberculosis]]
|-
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| bgcolor="Beige" |[[Brain tumor]], [[Craniopharyngioma]], [[Dystrophia adipose-genitalis]], [[Empty sella syndrome]], [[Frohlich's syndrome]], [[Glioma]], [[Hypothalamic tumor]], [[Meningioma]], [[Leukoencephalopathy with vanishing white matter|Ovarioleukodystrophy]], [[Traumatic brain injury]] 
|-
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| bgcolor="Beige" |[[Diet (nutrition)|Dietetic deficiency]], [[Galactose-1-phosphate uridyltransferase deficiency]], [[Underweight|Low weight]], [[Malabsorption syndrome]], [[Malnutrition]], [[Obesity]], [[Proprotein convertase|Proprotein convertase 1,3 deficiency]], [[Rapid weight loss]], [[Underweight]], [[Vitamin A|Vitamin A]] embryopathy, [[Weight gain]]
 
|-
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| bgcolor="Beige" |[[Anovulation]], [[Asherman syndrome]], [[Autoimmune hepatitis]], [[Oophoritis|Autoimmune oophoritis]], Cervical closure, [[Combined oral contraceptive pill]], [[Dilation and curettage (patient information)|Complications from D&C procedure]], [[Corpus luteum|Corpus luteum cyst]], [[Swyer's syndrome|Defect in SRY gene]], [[Ectopic pregnancy]], [[Asherman's syndrome|Endometrial scarring]], [[Follicle-stimulating hormone|FSH receptor deficiency]], [[Germinoma]], [[Granulosa cell tumor|Granulosa-cell tumor]], [[Hematocolpos]], [[Hematometra]], [[Hematosalpinx]], [[Hydatidiform mole]], [[Hypogonadism]], [[Hysterectomy]], [[Imperforate hymen]], [[Mayer-Rokitansky-Hauser syndrome|Mayer-Rokitansky syndrome]], [[Menopause]], [[Mullerian agenesis|Mullerian aplasia]], [[Mullerian dysgenesis]], [[Ovarian cancer]], [[Ovarian failure]], [[Ovarian insufficiency due to FSH resistance|Ovarian insufficiency due to FSH resistance]], [[Premature ovarian failure|Ovarian insufficiency - familial]], [[Leukoencephalopathy with vanishing white matter|Ovarioleukodystrophy]], Ovary damage, [[Menopause|Perimenopause]], [[Polycystic ovary syndrome]], [[Pregnancy]], [[Premature ovarian failure]], Pseudoamenorrhea, [[Pseudocyesis]], [[Reproduction|Reproductive disorders]], [[Sheehan syndrome]], [[Stein-Leventhal syndrome]], [[Tubal ligation|Tubal ligation syndrome]], [[mullerian agenesis|Uterine aplasia]], [[Vaginal agenesis]], [[Vaginal atresia|vaginal closure]], [[vaginal septum]], [[Ovarian cancer|Virilizing ovarian tumor]], [[Swyer's syndrome|XY female]] 
|-
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| bgcolor="Beige" |[[Granulosa cell tumor]], [[Hepatocellular carcinoma]], [[Hodgkin's disease]], [[Hypothalamic tumor]], [[Leukemia]], [[Meningioma]], [[Ovarian cancer]], [[Prolactinoma]], [[Ovarian cancer|Virilizing ovarian tumor]]
|-
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| bgcolor="Beige" | [[Alcohol poisoning|Alcohol poisoning]], [[Lead poisoning|Lead poisoning]], [[Mercury poisoning|Mercury poisoning]], [[Morphine|Morphine poisoning]]
|-
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| bgcolor="Beige" |[[Alcoholism]], [[Anorexia nervosa]], [[Anxiety]], [[Bulimia]], [[Depression]], [[Eating disorders]], [[Emotion|Emotional]] turmoil, Excessive [[Physical exercise|exercise]], [[Female athlete triad|Female athlete syndrome]], [[Grief]], [[Insanity]], [[Leukoencephalopathy with vanishing white matter|Ovarioleukodystrophy]], Primary affection disorder, [[Stress]]
|-
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| bgcolor="Beige" |[[Cystic fibrosis]], [[Tuberculosis]]
|-
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| bgcolor="Beige" |[[Chronic renal failure]], [[Denys-Drash syndrome]], [[Hypokalaemic distal renal tubular acidosis]], [[Nephritis]], [[Systemic lupus erythematosus]] 
|-
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| bgcolor="Beige" |[[Autoimmune adrenalitis]], [[Autoimmune hepatitis]], Autoimmune [[Oophoritis|oophoritis]], [[Celiac disease]], [[Systemic lupus erythematosus]]
|-
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| bgcolor="Beige" | No underlying causes
|-
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| bgcolor="Beige" |[[Traumatic brain injury]]
|-
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| bgcolor="Beige" |[[Frasier syndrome]]
|-
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| bgcolor="Beige" |[[Irradiation|Cranial irradiation]], [[Illness|Chronic illness]], [[Radiotherapy]]
|-
|}
 
===Causes in Alphabetical Order===
{{columns-list|
*[[5-alpha-reductase deficiency]]
*[[De Grouchy Syndrome|18p minus syndrome]]
*[[Achard-Thiers syndrome]]
*[[Acromegaly]]
*[[Addison's disease]]
*[[Adrenal cortex cancer|Adrenal cortex tumours]]
*[[Adrenal gland disorders]]
*[[Adrenocortical hyperplasia]]
*[[Vaginal agenesis|Agenesis of lower vagina]]
*Ahumada-del castillo syndrome
*[[Alcoholism]]
*[[Anemia]]
*[[Androgen insensitivity syndrome]]
*[[Anorexia nervosa]] <ref name="pmid25192814">{{cite journal| author=Abed J, Judeh H, Abed E, Kim M, Arabelo H, Gurunathan R| title="Fixing a heart": the game of electrolytes in anorexia nervosa. | journal=Nutr J | year= 2014 | volume= 13 | issue=  | pages= 90 | pmid=25192814 | doi=10.1186/1475-2891-13-90 | pmc=PMC4168120 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25192814  }} </ref>
*[[Anovulation]]
*[[Hypopituitarism|Anterior pituitary failure]]
*[[Antidepressants]]
*[[Antipsychotics]]
*[[Anxiety]]
*[[Arrhenoblastoma]]
*[[Asherman syndrome]]
*[[Autoimmune adrenalitis]]
*[[Autoimmune hepatitis ]]
*Autoimmune [[Oophoritis|oophoritis]]
*[[Bearn-Kunkel syndrome]]
*[[Brain tumor]]
*[[Breastfeeding]]
*[[Bulimia]]
*[[C21-hydroxylase deficiency]]
*[[Celiac disease ]]
*[[Cervical closure]]
*[[Chemotherapy]]
*[[Chiari-Frommel syndrome]]
*[[Chromosome 15q trisomy|Chromosome 15q duplication syndrome ]]
*Chromosome 17p, partial deletion
*[[Alcohol poisoning|Chronic alcohol poisoning]]
*[[Illness|Chronic illness]]
*[[Chronic renal failure]]
*[[Climate change]]
*[[Combined oral contraceptive pill]]
*[[Dilation and curettage (patient information)|Complications from D&C procedure]]
*[[Congenital adrenal hyperplasia]]
*[[Conn syndrome]]
*[[Constitutional delay of puberty]]
*[[Corpus luteum|Corpus luteum cyst ]]
*[[Cortisone reductase deficiency]]
*[[Irradiation|Cranial irradiation]]
*[[Craniopharyngioma]]
*[[Cretinism]]
*[[Cushing syndrome]]
*[[Cushing's disease]]
*[[Cyclophosphamide]]
*[[Cystic fibrosis]]
*[[Swyer's syndrome|Defect in SRY gene]]
*[[Denys-Drash syndrome]]
*[[Depression]]
*[[Diabetes mellitus]]
*[[Diet (nutrition)|Dietetic]] deficiency
*[[Down's syndrome]]
*[[Dystrophia adipose-genitalis]]
*[[Eating disorders]]<ref name="pmid19935043">{{cite journal| author=Andersen AE, Ryan GL| title=Eating disorders in the obstetric and gynecologic patient population. | journal=Obstet Gynecol | year= 2009 | volume= 114 | issue= 6 | pages= 1353-67 | pmid=19935043 | doi=10.1097/AOG.0b013e3181c070f9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19935043  }} </ref>
*[[Ectopic pregnancy]] <ref name="pmid25603672">{{cite journal| author=Shaikh NB, Shaikh S, Shaikh F| title=A clinical study of ectopic pregnancy. | journal=J Ayub Med Coll Abbottabad | year= 2014 | volume= 26 | issue= 2 | pages= 178-81 | pmid=25603672 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25603672  }} </ref>
*[[Emotion|Emotional]] turmoil
*[[Empty sella syndrome]]
*[[Asherman's syndrome|Endometrial scarring]]
*[[Epirubicin]]
*[[Ethanol]]
*Excessive [[Physical exercise|exercise]]
*Exogenous [[Androgen|androgen]] use
*[[Female athlete triad|Female athlete syndrome]]<ref name="pmid10865930">{{cite journal| author=Hobart JA, Smucker DR| title=The female athlete triad. | journal=Am Fam Physician | year= 2000 | volume= 61 | issue= 11 | pages= 3357-64, 3367 | pmid=10865930 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10865930  }} </ref>
*[[Fibroblast growth factor receptor 1|FGFR1]] mutation
*[[Fluoxymesterone]]
*[[Forbes-Albright syndrome]]
*[[Frasier syndrome]]
*[[Adiposogenital dystrophy|Fröhlich's syndrome]]
*[[Follicle-stimulating hormone|FSH receptor deficiency]]
*[[Galactorrhea]]
*[[Galactorrhea|Galactorrhoea-hyperprolactinaemia]]
*[[Galactose-1-phosphate uridyltransferase deficiency]]
*[[Germinoma]]
*[[Glioma]]
*[[GnRH|GnRH deficiency]]
*[[Gonadal dysgenesis]]
*[[Granulosa cell tumor]]
*[[Grief]]
*[[Hematometra]]
*[[Hemosiderosis]]
*[[Heart disease]]
*[[Hematocolpos]]
*[[Hematosalpinx]]
*[[Hepatocellular carcinoma]]
*[[Hodgkin's disease]]
*[[Hydatidiform mole]]
*[[Hyperprolactinaemia]]
*[[Hyperthyroidism]]
*[[Hypogonadism]]
*[[Hypogonadotropic hypogonadism]]
*[[Hypokalaemic distal renal tubular acidosis]]
*[[Hypopituitarism]]
*[[Hypothalamic tumor]]
*[[Hypothyroidism]]
*[[Hysterectomy]]
*[[Imperforate hymen]]
*[[Incomplete androgen insensitivity]]
*[[Inflammatory bowel disease]]
*[[Insanity]]
*[[KAL1 gene|Kal1 mutation]]
*[[Kallmann syndrome]]
*[[Laron syndrome ]]
*[[Laurence-Moon-Biedl syndrome]]
*[[Lead poisoning]]
*[[Leukemia]]
*[[Liver cirrhosis]]
*[[Underweight|Low weight]]
*[[Malabsorption syndrome]]
*[[Malnutrition]]
*[[Virilization|Masculinization disorders]]
*[[Mayer-Rokitansky-Hauser syndrome|Mayer-Rokitansky syndrome]]
*[[Medroxyprogesterone acetate]]
*[[Meningioma]]
*[[Menopause]]
*[[Metoclopramide]]
*[[Mercury poisoning]]
*[[morphine|Morphine]] poisoning
*[[Mullerian agenesis|Mullerian aplasia]]
*[[Mullerian dysgenesis]]
*[[Multiple endocrine neoplasia type 1 ]]
*[[Mumps]]
*[[Myxoedema]]
*[[Nandrolone]]
*[[Nephritis]]
*[[Obesity]]
*[[Oral contraceptives]]
*[[Ovarian cancer]]
*[[Ovarian failure]]
*[[Ovarian insufficiency due to FSH resistance|Ovarian insufficiency due to FSH resistance ]]
*[[Premature ovarian failure|Ovarian insufficiency, familial]]
*[[Leukoencephalopathy with vanishing white matter|Ovarioleukodystrophy]]
*[[Ovary damage]]
*[[Panhypopituitarism ]]
*[[Menopause|Perimenopause]]
*[[Pituitary apoplexy]]
*[[Laron syndrome|Pituitary dwarfism]]
*[[Pituitary infarct]]
*[[Pituitary tumour]]
*[[Polycystic ovary syndrome]]
*[[Prader-Willi syndrome ]]
*[[Pregnancy]]
*[[Premature ovarian failure]]
*[[Primary affective disorder]]
*[[Prokineticin receptor 2|PROKR2 mutation]]
*[[Prolactinoma]]
*[[proprotein convertase|Proprotein convertase 1/3]] deficiency
*[[Pseudoamenorrhea]]
*[[Pseudocyesis]]
*[[pseudohermaphroditism|Pseudohermaphroditism, female]]
*[[Radiotherapy]]
*[[Rapid weight loss]]
*[[Reproduction|Reproductive disorders]]
*[[Sheehan syndrome]]
*[[Simmonds' disease]]
*[[Spironolactone]]
*[[Stanozolol]]
*[[Stein-Leventhal Syndrome]]
*[[Stress]]
*[[Systemic lupus erythematosus]]
*[[Testicular feminization syndrome]]
*[[Testosterone]]
*[[48, XXXX|Tetrasomy X]]
*[[Thyrotoxicosis]]
*[[Traumatic brain injury]]
*[[Triple X syndrome]]
*[[Tubal ligation|Tubal ligation]]syndrome
*[[Tuberculosis]]
*[[Turner syndrome]]
*[[Underweight]]
*[[Mullerian agenesis|Uterine aplasia]]
*[[Vaginal agenesis]]
*[[Vaginal atresia|Vaginal closure]]
*[[Vaginal septum]]
*[[Ovarian cancer|Virilizing ovarian tumor]]
*[[Vitamin A|Vitamin A]] embryopathy
*[[Weight gain]]
*[[Werner syndrome]]
*[[Swyer's syndrome|XY female]]


}}


==Causes==
==Causes Based on Classification==
=== Primary Amenorrhea<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
=== <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref>===
* [[17 beta-hydroxysteroid dehydrogenase deficiency]]
* [[17 beta-hydroxysteroid dehydrogenase deficiency]]
* [[Agonadism]]
* [[Agonadism]]
* After trauma
* [[Anorexia Nervosa]]
* [[Anorexia Nervosa]]
* [[Anovulation]]
* [[Anovulation]]
Line 20: Line 428:
* [[Constitutional delay of puberty]]  
* [[Constitutional delay of puberty]]  
* [[Diabetes Mellitus]]
* [[Diabetes Mellitus]]
* Early infantile brain damage
* Early infantile [[brain]] damage
* [[Gonadal dysgenesis]]
* [[Gonadal dysgenesis]]
* [[adrenogenital syndrome|Homozygous adrenogenital syndrome]]
* [[adrenogenital syndrome|Homozygous adrenogenital syndrome]]
* [[Hymenal atresia]]
* [[Hymenal atresia]]
* [[Hyperandrogenism]]
* [[Hyperandrogenism]]
* Hypothalamic and [[pituitary tumor]]s
* [[Hypothalamic]] and [[pituitary tumor]]s
*:* [[Hyperprolactinemia]] / [[Prolactin-secreting tumors]]
** [[Hyperprolactinemia]] / [[Prolactin-secreting tumors]]
*:* [[Dysgerminoma]]
** [[Dysgerminoma]]
*:* [[Craniopharyngioma]]
** [[Craniopharyngioma]]
* [[Idiopathic gonadotropin deficiency]]
* [[Idiopathic gonadotropin deficiency]]
* [[Kallmann's Syndrome]]
* [[Kallmann's Syndrome]]
Line 35: Line 443:
* Outflow tract disorders
* Outflow tract disorders
* [[Pituitary insufficiency]]
* [[Pituitary insufficiency]]
*:* [[schistosomiasis|Pituitary schistosomiasis]]
** [[schistosomiasis|Pituitary schistosomiasis]]
*:* [[tuberculosis|Pituitary tuberculosis]]
** [[tuberculosis|Pituitary tuberculosis]]
*:* [[Empty Sella Syndrome]]
** [[Empty Sella Syndrome]]
* [[Polycystic Ovary Syndrome]]
* [[Polycystic Ovary Syndrome]]
* Post-hormonal contraceptive [[Amenorrhea]]
* Post-hormonal [[contraceptive]] amenorrhea
* Severe systemic diseases
* Severe systemic diseases
* [[Swyer's Syndrome]]
* [[Swyer's Syndrome]]
* [[Testicular feminization]]
* [[Testicular feminization]]
* [[Trauma]]
* [[Turner's Syndrome]]
* [[Turner's Syndrome]]
* [[Uterine atresia]]
* [[Uterine atresia]]
Line 50: Line 459:
=== Secondary Amenorrhea ===
=== Secondary Amenorrhea ===
* [[5-alpha-reductase deficiency]]
* [[5-alpha-reductase deficiency]]
* Addiction
* [[Addiction]]
* [[Addison's Disease]]
* [[Addison's Disease]]
* [[Adrenocortical insuffiency]]
* [[Adrenocortical insuffiency]]
* After [[curettage]]
* After [[hysterectomy]]
* After [[radiation]] (can be reversed)
* [[Adrenal tumor]]s
* [[Adrenal tumor]]s
* [[Anovulation]]
* [[Asherman's Syndrome]]
* [[Asherman's Syndrome]]
* Autoimmune diseases
* [[Autoimmune diseases]]
* Body building (and use of androgens)
* Body building (use of [[androgens]])
* Castration (radiation or surgical)
* [[Castration]] ([[radiation]] or surgical)
* Central nervous system tumor (CNS)
* [[Central nervous system|Central nervous system (CNS)]] tumor
* Cervical stenosis
* [[Cervical]] stenosis
* Change of environment
* Change of environment
* Complete and incomplete [[androgen insensitivity]]  
* Complete and incomplete [[androgen insensitivity]]  
* [[Congenital adrenal hyperplasia]]
* [[Congenital adrenal hyperplasia]]
* Craniocerebral [[trauma]]
* Craniocerebral [[trauma]]
* [[Curettage]]
* [[Cushing's Syndrome]]
* [[Cushing's Syndrome]]
* [[Depression]]
* [[Depression]]
* [[Diabetes Mellitus]]
* [[Diabetes Mellitus]]
* Drug Side Effect- [[Medroxyprogesterone]], [[Norgestimate and Ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol]], [[Methyltestosterone]], [[Olanzapine]], [[Pramipexole]]
* Drug Side Effect ([[Chlorpromazine]], [[Desogestrel and Ethinyl Estradiol]], [[Docetaxel]], [[Epirubicin hydrochloride]], [[Ethynodiol diacetate and ethinyl estradiol]], [[Fluoxymesterone]], [[Histrelin]], [[Iloperidone]], [[Loxapine]], [[Medroxyprogesterone]], [[Norgestimate and Ethinyl estradiol]], [[Norgestrel and Ethinyl estradiol]], [[Sertraline]], [[Methyltestosterone]], [[Olanzapine]], [[Pramipexole]], [[Prochlorperazine]], [[Tiagabine]], and [[Trifluoperazine]])
* [[Encephalitis]]
* [[Encephalitis]]
* Enzymatic defects in [[testosterone]] biosynthesis
* [[Enzymatic]] defects in [[testosterone]] biosynthesis
* Exposure to maternal androgens in utero
* Exposure to maternal [[androgens]] [[in utero]]
* [[Obesity|Extreme obesity]]
* [[Obesity|Extreme obesity]]
* During [[chemotherapy]]
* During [[chemotherapy]]
* Functional hypothalalmic [[Amenorrhea]] due to:
* [[Gonadotropin]] deficiency in tumors
*:* Stress
* Hormone-active [[ovarian]] tumor
*:* [[Eating disorders]]
*:* Excessive exercise
*:* [[Weight loss]]
* Gonadotropin deficiency in tumors
* Hormone-active ovarian tumor
* [[Hermaphroditism]]
* [[Hermaphroditism]]
* Heterozygous [[adrenogenital syndrome]]
* Heterozygous [[adrenogenital syndrome]]
Line 92: Line 493:
* Imprisonment
* Imprisonment
* [[Meningitis]]
* [[Meningitis]]
* Mullerian anomalies
* [[Mullerian dysgenesis|Mullerian anomalies]]
* [[Myotonic dystrophy]]
* [[Myotonic dystrophy]]
* [[Pituitary insufficiency]]
* [[Pituitary insufficiency]]
* [[Polycystic ovary syndrome]]
* [[Polycystic ovary syndrome]]
* Post-hormonal contraception
* Post-hormonal [[contraception]]
* Post-infection ([[mumps]], severe [[pelvic inflammatory disease]])  
* Post-infection ([[mumps]] and severe [[pelvic inflammatory disease]])  
* Postoerative gonadotropin deficiency
* Post-operative [[gonadotropin]] deficiency
* [[Pregnancy]]
* [[Pregnancy]]
* Premature [[menopause]]
* Premature [[menopause]]
* [[Prolactinoma]]
* [[Prolactinoma]]
* [[Radiation]]
* [[Sheehan's Syndrome]]
* [[Sheehan's Syndrome]]
* [[Stress]]
* [[Testicular feminization]]
* [[Testicular feminization]]
* Transsexuality when taking androgens
* [[Transsexuality]] when taking androgens
* [[Turner's Syndrome]]
* [[Turner's Syndrome]]
* Uterine cavity sclerosis
*:* Uterine [[Schistosomiasis]]
*:* [[Abortion]]
*:* Severe generalized infections of the pelvis
*:* Post uterine surgery
*:* Overzealous or repeated uterine curettage
*:* [[Tuberculosis]] [[endometritis]]


== Differential Diagnosis Organized by Category of Causes==
* [[Uterine]] cavity sclerosis
* '''Physiologic'''
** [[Uterine]] [[Schistosomiasis]]
*:*  [[Pregnancy]]
** [[Abortion]]
*:* [[Lactation]]
** Severe generalized [[infections]] of the [[pelvis]]
*:*  [[Menopause]]
** Post uterine surgery
* '''Hypothalamic'''
** Overzealous or repeated uterine [[curettage]]
*:*  Structural
** [[Tuberculosis]] [[endometritis]]
*:*:* [[Craniopharyngioma]]
 
*:*:* [[Lymphoma]]
=== Functional amenorrhea ===
*:*:* [[Sarcoidosis]]
* [[Stress]]
*:*:* [[Hemochromatosis]]
* [[Eating disorders]]
*:*  Functional
* Excessive [[exercise]]
*:*:* [[Anorexia]]/[[bulimia]]
* [[Weight loss]]
*:*:* Excessive exercise/[[weight loss]]
*:*:* [[Stress]]
* ''' Pituitary '''
*:*  Secretory tumors
*:*:* [[Prolactinoma]]
*:*:* [[Cushing’s disease]]
*:*:* [[Acromegaly]]
*:*  Destructive lesions
*:*:* Non-functional tumors
*:*:* [[Sheehan's syndrome]]
*:*:* [[Hemochromatosis]]
* ''' Ovarian '''
*:*  [[Premature ovarian failure]]
*:*  Hyperandrogenic disorders
*:*:* [[Polycystic ovary syndrome]] ([[PCOS]])
*:*:* Nonclassical [[congenital adrenal hyperplasia]] (NCCAH)
*:*:* Adrenal/ovarian androgen-secreting tumors
* ''' Anatomic '''
*:*  Destruction of uterine cavity
*:*:* [[Asherman’s syndrome]]
*:*:* [[Tuberculosis]] ([[TB]])
*  ''' Other '''
*:*  [[Hyperthyroidism]]/[[hypothyroidism]]
*:*  [[Cushing’s syndrome]]


==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], Kiran Singh, M.D. [3]

Overview

Common causes of amenorrhea are breastfeeding, pregnancy, menopause, and stress. Common causes of primary amenorrhea are craniopharyngioma, idiopathic gonadotropin deficiency, Kallmann's Syndrome, Mayer-Rokitansky-Hauser Syndrome, Mullerian dysgenesis, and outflow tract disorders. Common causes of secondary amenorrhea are craniocerebral trauma, curettage, Cushing's Syndrome, depression, diabetes mellitus, and drug side effects. Common causes of functional amenorrhea are stress, rapid weight loss, and excessive exercise.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of amenorrhea, however complications resulting from untreated amenorrhea are common.

Common Causes

Less Common Causes

Causes by Organ System

Cardiovascular Haemosiderosis, heart disease
Chemical/Poisoning Alcoholism, Alcohol poisoning, Lead poisoning, Mercury poisoning, Morphine poisoning
Dental No underlying causes
Dermatologic Systemic lupus erythematosus
Drug Side Effect Antidepressants, Antipsychotics, Chemotherapy, Combined oral contraceptive pill, Cyclophosphamide, Epirubicin, Ethanol, Fluoxymesterone, Medroxy-progesterone acetate, Metoclopramide, Nandrolone, Spironolactone, Stanozolol
Ear Nose Throat No underlying causes
Endocrine Acromegaly, 5-alpha-reductase deficiency, Achard-Thiers syndrome, Addison's disease, Adrenal cortex tumours, Adrenal gland disorders, Adrenocortical hyperplasia, Ahumada-Del Castillo syndrome, Androgen insensitivity syndrome, Anorexia nervosa, Anovulation, Anterior pituitary failure, Arrhenoblastoma, Autoimmune adrenalitis, Breastfeeding, C21-hydroxylase deficiency, Chiari-Frommel syndrome, Congenital adrenal hyperplasia , Conn syndrome, Constitutional delay of puberty, Corpus luteum cyst, Cortisone reductase deficiency, Cretinism, Cushing's disease, Cushing syndrome, Diabetes mellitus, Dystrophia adipose-genitalis, Eating disorders, Empty sella syndrome, Exogenous androgen use, Female athlete syndrome, Forbes-Albright syndrome, Frohlich's syndrome, FSH receptor deficiency, Galactorrhea, Galactorrhoea-hyperprolactinaemia, GnRH deficiency, Hyperprolactinaemia, Hyperthyroidism, Hypogonadism, Hypogonadotropic hypogonadism, Hypopituitarism, Hypothyroidism, Incomplete androgen insensitivity, Kallmann syndrome, Laron syndrome , Masculinization disorders, Mayer-Rokitansky syndrome, Menopause, Mullerian aplasia, Mullerian dysgenesis, Multiple endocrine neoplasia type 1, Myxoedema, Obesity, Ovarian failure, Ovarian insufficiency due to FSH resistance, Familial ovarian insufficiency, Panhypopituitarism, Perimenopause, Pituitary apoplexy, Pituitary dwarfism, Pituitary infarct, Pituitary tumour, Polycystic ovary syndrome, Premature ovarian failure, Prolactinoma, Pseudoamenorrhea, Pseudocyesis, Rapid weight loss, Sheehan syndrome, Simmonds' disease, Stein-Leventhal syndrome, Testicular feminization syndrome, Testosterone, Thyrotoxicosis, Underweight, Weight gain, XY female
Environmental Climate change
Gastroenterologic Anorexia nervosa, Autoimmune hepatitis, Bearn-Kunkel syndrome, Celiac disease , Cystic fibrosis, Eating disorders, Hemosiderosis, Hepatocellular carcinoma, Inflammatory bowel disease, Liver cirrhosis, Malabsorption syndrome, Rapid weight loss, Weight gain
Genetic 18p minus syndrome, Agenesis of lower vagina, Androgen insensitivity syndrome, C21-hydroxylase deficiency, Celiac disease, Chromosome 15q duplication syndrome, Chromosome 17p - partial deletion, Cortisone reductase deficiency, Defect in sry gene, Cystic fibrosis, Down's syndrome, FGFR1 mutation, Galactose-1-phosphate uridyltransferase deficiency, Gonadal dysgenesis, Kal1 mutation, Kallmann syndrome, Laurence-Moon-Biedl syndrome, Mayer-Rokitansky syndrome, Ovarian insufficiency - familial, Prader-Willi syndrome , PROKR2 mutation, Tetrasomy X, Triple X syndrome, Turner syndrome, Werner syndrome, XY female
Hematologic Anemia, Hemosiderosis, Hodgkin's disease, Leukemia
Iatrogenic Antidepressants, Antipsychotics, Chemotherapy, Combined oral contraceptive pill, Cyclophosphamide, Epirubicin, Ethanol, Fluoxymesterone, Medroxy-progesterone acetate, Metoclopramide, Nandrolone, Spironolactone, Stanozolol
Infectious Disease Mumps, Tuberculosis
Musculoskeletal/Orthopedic No underlying causes
Neurologic Brain tumor, Craniopharyngioma, Dystrophia adipose-genitalis, Empty sella syndrome, Frohlich's syndrome, Glioma, Hypothalamic tumor, Meningioma, Ovarioleukodystrophy, Traumatic brain injury
Nutritional/Metabolic Dietetic deficiency, Galactose-1-phosphate uridyltransferase deficiency, Low weight, Malabsorption syndrome, Malnutrition, Obesity, Proprotein convertase 1,3 deficiency, Rapid weight loss, Underweight, Vitamin A embryopathy, Weight gain
Obstetric/Gynecologic Anovulation, Asherman syndrome, Autoimmune hepatitis, Autoimmune oophoritis, Cervical closure, Combined oral contraceptive pill, Complications from D&C procedure, Corpus luteum cyst, Defect in SRY gene, Ectopic pregnancy, Endometrial scarring, FSH receptor deficiency, Germinoma, Granulosa-cell tumor, Hematocolpos, Hematometra, Hematosalpinx, Hydatidiform mole, Hypogonadism, Hysterectomy, Imperforate hymen, Mayer-Rokitansky syndrome, Menopause, Mullerian aplasia, Mullerian dysgenesis, Ovarian cancer, Ovarian failure, Ovarian insufficiency due to FSH resistance, Ovarian insufficiency - familial, Ovarioleukodystrophy, Ovary damage, Perimenopause, Polycystic ovary syndrome, Pregnancy, Premature ovarian failure, Pseudoamenorrhea, Pseudocyesis, Reproductive disorders, Sheehan syndrome, Stein-Leventhal syndrome, Tubal ligation syndrome, Uterine aplasia, Vaginal agenesis, vaginal closure, vaginal septum, Virilizing ovarian tumor, XY female
Oncologic Granulosa cell tumor, Hepatocellular carcinoma, Hodgkin's disease, Hypothalamic tumor, Leukemia, Meningioma, Ovarian cancer, Prolactinoma, Virilizing ovarian tumor
Ophthalmologic No underlying causes
Overdose/Toxicity Alcohol poisoning, Lead poisoning, Mercury poisoning, Morphine poisoning
Psychiatric Alcoholism, Anorexia nervosa, Anxiety, Bulimia, Depression, Eating disorders, Emotional turmoil, Excessive exercise, Female athlete syndrome, Grief, Insanity, Ovarioleukodystrophy, Primary affection disorder, Stress
Pulmonary Cystic fibrosis, Tuberculosis
Renal/Electrolyte Chronic renal failure, Denys-Drash syndrome, Hypokalaemic distal renal tubular acidosis, Nephritis, Systemic lupus erythematosus
Rheumatology/Immunology/Allergy Autoimmune adrenalitis, Autoimmune hepatitis, Autoimmune oophoritis, Celiac disease, Systemic lupus erythematosus
Sexual No underlying causes
Trauma Traumatic brain injury
Urologic Frasier syndrome
Miscellaneous Cranial irradiation, Chronic illness, Radiotherapy

Causes in Alphabetical Order

Causes Based on Classification

[5]

Secondary Amenorrhea

Functional amenorrhea

References

  1. ↑ Abed J, Judeh H, Abed E, Kim M, Arabelo H, Gurunathan R (2014). ""Fixing a heart": the game of electrolytes in anorexia nervosa". Nutr J. 13: 90. doi:10.1186/1475-2891-13-90. PMC 4168120. PMID 25192814.
  2. ↑ Andersen AE, Ryan GL (2009). "Eating disorders in the obstetric and gynecologic patient population". Obstet Gynecol. 114 (6): 1353–67. doi:10.1097/AOG.0b013e3181c070f9. PMID 19935043.
  3. ↑ Shaikh NB, Shaikh S, Shaikh F (2014). "A clinical study of ectopic pregnancy". J Ayub Med Coll Abbottabad. 26 (2): 178–81. PMID 25603672.
  4. ↑ Hobart JA, Smucker DR (2000). "The female athlete triad". Am Fam Physician. 61 (11): 3357–64, 3367. PMID 10865930.
  5. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

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