Registered users can save articles, searches, and manage email alerts. Primary dysmenorrhea refers to common menstrual cramps, while secondary dysmenorrhea results from a disorder in the reproductive organs. Causes include anorexia nervosa, disease of the female reproductive tract, and overexercise secondary amenorrhea can also be caused by certain medications, notably the birth control medication medroxyprogesterone brand name. Evaluation and management of a patient with amenorrhea is common in gynecology, and the prevalence of pathologic amenorrhea ranges from 3 to 4 percent in reproductiveaged populations bachmann, 1982. The first diagnostic step is determining whether amenorrhea is primary before menarche or secondary after menarche. Apr 19, 2018 secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence of pregnancy, breastfeeding or menopause. 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. Symposium on adolescent gynecology and endocrinology. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. Congenital adrenal hyperplasia secondary to 17hydroxylase. Gynecology usmle prep video course study with lecturio. The female patients aged between 1025years having short stature with or without primary or secondary amenorrhea who were referred to the cytogenetic outdoor for chromosomal analysis from the departments of pediatric medicine, endocrinology, gynaecology from different hospitals of eastern india were included in the study. The pathophysiology of amenorrhea in the adolescent neville h. Difference between amenorrhea and menopause compare the.
For example, the most common cause of secondary amenorrhea is pregnancy. Secondary amenorrhea can occur due to natural changes in the body. Secondary amenorrhea is due to pregnancy, stress, illness or other causes. Any associated symptoms depend on the problem that is causing the amenorrhea. Definition secondary amenorrhoea refers to absence of menses for over 3 months in women who previously had regular menstrual cycles, or 6 months in women who had irregular menses.
This article is from daru journal of pharmaceutical sciences, volume 20. Due to the contraindications and side effects of it and the increasing demand for alternative medicine substitutes, mentha longifolia l. Study showed that prl levels should be kept in consideration during the diagnosis and management of secondary amenorrhea as the prl values were found to be significant 22%. See epidemiology and causes of secondary amenorrhea and evaluation and management of. Treatment options differ for both primary and secondary amenorrhea. To determine the risk for secondary amenorrhea after pulse cyclophosphamide therapy in premenopausal women with systemic lupus erythematosus. If a teenager does not have a menstrual period by age 16, it is called primary amenorrhea. N94 pain and other conditions associated with female genital organs and menstrual cycle. Secondary amenorrhoea absence of menses for more than three cycles or 6 months in women who previously had menses. Two sisters with amenorrhea, hypokalemia, hypertension, and cystic ovaries. Hence, we investigated the prevalence of secondary amenorrhea among all females n 1099 that consulted in our clinic, grouped by age 1550 yrs, time months of amenorrea and identifying the. The lactational amenorrhea method does not protect against sexually transmitted diseases stds, including human immunodeficiency virus hiv, and women using this method should be counseled that consistent and correct use of the male latex condom reduces the risk for transmission of hiv and other stds. For example, hormone imbalances may cause amenorrhea together with. Nov 30, 2015 magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0.
Amenorrhea means you do not have menstrual periods. It is a symptom of different diseases, such as hormonal disturbances which range from pituitary to ovarian origin, as well as chromosomal abnormalities. Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who havent begun menstruation by age 15. However, patients with previously regular cycles are evaluated for secondary amenorrhea if menses have been absent for. Hyperprolactinemia, characterized by high levels of the hormone prolactin, is often associated with a. Secondary amenorrhea testing algorithm arupconsult. Secondary amenorrhea testing indications for testing amenorrhea with negative pregnancy test order prolactin luteinizing hormone and follicle stimulating hormone.
We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. The bellagio consensus provided the scientific basis for defining the conditions under which breastfeeding can be used safely and effectively for birthspacing purposes. Amenorrhea absent or poor secondary sex characteristics fsh serum level low normal high hypogonadotropic hypogonadim gonadal dysgenesis 27. Download pdf 77 kb abstract this issue of emedref provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of secondary amenorrhea. Congenital adrenal hyperplasia secondary to 17hydroxylase deficiency. The association of secondary amenorrhea with extreme forms of substance use, weight control, and exercise in nonrepresentative samples raises questions as to whether adolescents in the general population who engage in these behaviors are at increased risk for secondary amenorrhea. We will also provide a clinical evaluation approach for these women, and establish some treatment principles related to amenorrhea. Hypothalamus pituitary ovary uterus cervix vagina involved structurally in the outflow of menstrual blood involved in endocrine regulation of the menstrual cycle. Neuroendocrine causes of amenorrheaan update the journal. Secondary and primary amenorrhea definition, causes, treatment. Amenorrhea uhmenoreeuh is the absence of menstruation one or more missed menstrual periods. Amenorrhea, oligomenorrhea amenorrhea primary amenorrhea no menarche by age 14 without secondary sexual characteristics no menarche by age 16 with secondary sexual characteristics secondary amenorrhea absence of menses in a previously menstruating woman no menses for 3 cycle lengths in previously cycling woman or. Secondary amenorrhea occurs quite often in women who engage in activities associated with lower body weight, such as ballet and gymnastics. Feb 26, 2019 secondary amenorrhea involves the cessation of menstruation in a woman who previously had a regular menstrual cycle.
An understanding of the neuroendocrine causes of amenorrhea and infertility is therefore critical when evaluating patients presenting with these complaints in order to implement the most appropriate treatment regimen. Most cases of secondary amenorrhea can be attributed to. Irregular or absent menstrual periods should trigger an evaluation to identify the root cause. Extreme weight gain or loss, certain medications, as well as anxiety can be the root cause of amenorrhea. Breastfeeding and menopause are also common, but natural, causes. 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. Most common cause of secondary amenorrhea rule out with a urine or serum hcg before proceeding consider each level of the control of the menstrual cycle. After looking for more information on oral contraceptives leading to amenorrhea, i have found some information that will improve this article. Risk for sustained amenorrhea in patients with systemic. Arabian gulf university kingdom of bahrain year 5 gynecology and obstetrics 7th week salmanya medical complex dr. If a female of reproductive age fails to menstruate for 6 consecutive months, it is called the secondary amenorrhea. The estimation should be done in cases with ho anovulation, infertility, secondary amenorrhea and abnormal menses. Amenorrhea is the absence of a menstrual period in a woman of reproductive age.
Secondary amenorrhea testing algorithm arup consult. Department of pathology and laboratory medicine, emory university, atlanta, ga. Adolescent smoking, weight changes, and bingepurge behavior. Amenorrhea, the absence of menses, is a common problem in the primary care setting. Pdf disruptions in the menstrual cycle are a common complaint in primary care and womens health. Serum prolactin assay in secondary amenorrhea and infertility. Hypothalamic dysfunction in secondary amenorrhea associated with simple weight loss. A pregnancy test is a common first step for diagnosis. Amenorrhea, the absence of menstrual bleeding, can be either primary or secondary. Amenorrhea is the loss or lack of menstrual periods. Increased serum fsh, decreased serum estradiol either measured directly or indicated by a lack of bleeding following a progestin challenge test, and an fmr1 cgg repeat region in the premutation range are diagnostic of fxpoi. Mar 17, 2011 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. Multiple laboratory test results must be evaluated, because no single test is diagnostic of the distinct etiologies of secondary amenorrhea. Weightrelated amenorrhoea anorexia nervosa 1 o or 2 o amenorrhea is often first sign a body mass index bmi pdf created with pdffactory trial version.
A young woman with yellow hands and secondary amenorrhoea. Amenorrhea is the absence of menstruation and it is classified into two categories as primary and secondary amenorrhea. The pdf contains the who classification for secondary amenorrhea but was not part of the lecture. This condition may be transient, intermittent, or permanent, and usually results from congenital, neuroendocrine, or anatomic abnormalities. Secondary amenorrhea means you have had periods, and then they stop, especially for more than 3 months. Often a diagnosis of exclusion, it is one of the most common causes of secondary amenorrhea 7. Carlson division of adolescent medicine, stanford university school of medicine, mountain view, california, usa menstrual irregularity is a common occurrence during adolescence, especially within the.
This article discusses secondary amenorrhea and provides a systematic approach to its diagnostic evaluation, with referral considerations. Easy bruising in a patient with secondary amenorrhea. Secondary amenorrhea occurs when a woman stops having periods for three or more months in a row after having regular periods in the past. Aug 01, 2014 secondary amenorrhea is not, in itself, a cause for concern.
The etiologic and diagnostic considerations for oligomenorrhea are the same as for secondary amenorrhea. Because the urethral smear method is simple, economical, and rapid, it appears worthwhile to point out the advantages to be obtained in differential diagnosis fromthistest. Dysmenorrhea is the medical term for menstrual cramps, which are caused by uterine contractions. Secondary amenorrheas most common and most easily diagnosable causes are pregnancy, thyroid disease, and hyperprolactinemia. These files will have pdf in brackets along with the filesize of the download. But to avoid complications you must address the underlying conditions that cause amenorrhea. Secondary amenorrhea usually isnt harmful to your health. There are two types of amenorrhea primary or secondary. Image 1a t1 weighted, 1b and 1c t2 weighted magnetic resonance imaging. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. If secondary amenorrhoea is anenore early in life, for example through excessive exercise or weight loss, menarche may not return later in life. If a girl fails to menstruate by the age of 16 years, it is called the primary amenorrhea. The most common etiologies are pregnancy and polycystic ovarian syndrome pcos. Primary amenorrhea is defi ned as absence of menstruation by age 14 with absence of growth or development of secondary sexual characteristic or as absence of menstruation by 16 years regardless of presence of normal growth and development of secondary sexual characteristics 1.
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. Risk for sustained amenorrhea in patients with systemic lupus erythematosus receiving intermittent pulse cyclophosphamide therapy. Epidemiology and causes of secondary amenorrhea uptodate. Patients who qualify by statute for osteoporosis screening may be evaluated by studies that are characterized by cpt codes 77078, 77080, 77081, 77085, 76977, and g0. The pathophysiology of amenorrhea in the adolescent. Details on treatments and causes of amenorrhea the absence of a monthly period are provided.
After completing this activity, the participant should be better able to. Archive of sid 232 archives of iranian medicine, volume 15, number 4, april 2012 original article abstract background. Archived from the original on 29 january causes of secondary amenorrhea can also result in primary amenorrhea, especially maenore present before onset of menarche. More to know causes of secondary amenorrhea include pregnancy, hormone imbalances, stress, thyroid conditions, ovarian cysts, being too thin, and longterm illness.
Three months or more without a menstrual period in a woman is the definition of. Choose when to start an evaluation for secondary amenorrhea2. Up to 50% of competitive runners training 80 miles per week and up to 44% of ballet dancers have amenorrhea. Secondary amenorrhea district i acog medical student education module 2011 definitions amenorrhea. Primary amenorrhea is due to changes in organs, glands, and hormones related to menstruation. The cessation of menstruation for abnormal reasons. Cdc lactational amenorrhea method usmec reproductive. The evaluation and management of secondary amenorrhea and the causes, evaluation, and management of primary amenorrhea are discussed separately. Primary amenorrhea means you never start your periods. Secondary amenorrhea is present when a young woman ceases to menstruate after she has had one or more menstrual periods. Over 50% of cases of secondary amenorrhea result from perturbations in the hypothalamicpituitaryadrenal hpa axis. I added an internal link to the page for secondary sex characteristics and provided a couple examples on this page to provide clarity. The association of secondary amenorrhea with extreme forms of substance use, weight control, and exercise in nonrepresentative samples raises questions as to whether adolescents in the general population who engage in these. Adolescent smoking, weight changes, and bingepurge.
Pdf most of the documents on the racgp website are in portable document format pdf. Even if you dont have periods, you could still get pregnant. Many adult women are happy to forgo the inconvenience of a monthly period. Learning objectives and cmedisclosure information this activity is intended for healthcare providers delivering care to women and their families. Hypothalamic amenorrhea is typically characterized by amenorrhea in the absence of anatomic, chromosomal or organic abnormalities. Cdc lactational amenorrhea method usmec reproductive health. Amenorrhea with absent or poor secondary sex characters 2. Secondary amenorrhea is defined as the absence of menstrual flow in women with previously normal menstruation. Secondary amenorrhea is defined as the cessation of regular menses for three months or the ces sation of irregular menses for six months. The epidemiology and causes of secondary amenorrhea and overviews of primary amenorrhea and abnormal uterine bleeding in adolescents are discussed separately. Primary amenorrhea with transverse vaginal septum and. Secondary amenorrhea will affect approximately 5% of women of reproductive age and those who are affected often will not demonstrate an obvious etiology for their symptoms.
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