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 may be classified according to etiology into three subtypes, including primary amenorrhea, secondary amenorrhea, and functional amenorrhea. Primary amenorrhea is basically referred to a young girl that has not experienced menarche, at all, classified as hypergonadotropic hypogonadism, hypogonadotropic hypogonadism, and eugonadotropic state. Secondary amenorrhea reflects a woman that has ordinary menstruation cycles, experiencing at least 3 months of menstruation cycle absence, classified as polycystic ovary syndrome, hypothalamic-pituitary dysfunction, hypothalamic-pituitary failure, and ovarian failure. Functional amenorrhea is a subtype of the amenorrhea caused by exaggerated different lifestyles, classified as stress, weight loss, and exercise related groups.
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 | Primary amenorrhea | Secondary amenorrhea | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stress related | Weight loss related | Exercise related | Present uterus | Absent uterus | Polycystic ovary syndrome | Hypothalamic-pituitary dysfunction | Hypothalamic-pituitary failure | Ovarian failure | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Hypergonadotropic hypogonadism | Hypogonadotropic hypogonadism | Eugonadotropic | Mullerian agenesis | Androgen insensitivity | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Primary amenorrhea
- Primary amenorrhea is basically referred to a adolescent girl that has not experienced menarche, at all. It is defined as one of the followings:[1][2][3]
- Normal secondary sexual characteristics without menarche by 16 years of age
- Lack of secondary sexual characteristics and no menarche by 14 years of age
- Lack of menarche five years after initial breast development (thelarche)
- The first issue that is important in a patient with primary amenorrhea is presence or absence of uterus. If uterus is present, primary amenorrhea can be classified depend 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). While, when the reason of amenorrhea is lack of uterus, it can be due to mullerian agenesis or androgen insensitivity.[4]
Secondary amenorrhea
- Secondary amenorrhea is in fact more common than primary amenorrhea. It is defined as one of the followings:[4]
- Three months of menstruation cycle absence in a woman that had ordinary menstruation cycles before
- Nine months of menstruation cycle absence in a women that had oligomenorrhea before
- Most pathological causes of secondary amenorrhea can be classified as polycystic ovary syndrome (PCOS), hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian failure.[1][5][6]
Functional amenorrhea
- Functional amenorrhea is a subtype of the amenorrhea caused by exaggerated different lifestyles. It is classified to stress, weight loss, and exercise related subtypes.[7]
- It is defined as lack of menstruation cycle for 6 months due to hypothalamic-pituitary-ovarian axis disturbance, without any anatomical or organic pathology.[8]
- Generally, the main issue that caused functional amenorrhea is lack of gonadotropin releasing hormone (GnRH) pulsatility.[9]
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.
- ↑ 4.0 4.1 Klein DA, Poth MA (2013). "Amenorrhea: an approach to diagnosis and management". Am Fam Physician. 87 (11): 781–8. PMID 23939500.
- ↑ 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.