Amenorrhea is the transient or permanent absence of menstrual flow and may be subdivided into primary and secondary presentations, relative to menarche. Secondary amenorrhea district i acog medical student education module 2011 definitions amenorrhea. Magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Amenorrhea, the absence of menstrual bleeding, can be either primary or secondary. 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. 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. Nov 30, 2015 magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0.
Evaluation should begin if no pubertal development has occurred by age, if menarche has not occurred by age 15, or if menarche has not occurred within five years of thelarche. C, 6 women with polycystic ovary syndrome should be tested for glucose intolerance. It is important to consider all causes of secondary amenorrhea in the evaluation of primary amenorrhea. It is caused by dysfunctioning of the pituitary gland, ovaries, uterus, and hypothalamus, by surgical removal of the ovaries or uterus, by medication, or by emotional trauma. The author has disclosed no potential conflicts of interest, financial or otherwise. Absence must be for 3 cycles according to certain sources 6 months according to most sources. Carlson division of adolescent medicine, stanford university school of medicine, mountain view, california, usa menstrual irregularity is a common occurrence during adolescence, especially within. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. Secondary and primary amenorrhea definition, causes, treatment.
View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Up to 50% of competitive runners training 80 miles per week and up to 44% of ballet dancers have amenorrhea. In contrast, if menstruation has begun but has subsequently ceased for more than three cycles or 6 months, the term secondary amenorrhea is used. However, at age years, if no menses have occurred and there is a complete absence of secondary sexual characteristics such as breast development, evaluation for primary amenorrhea should. This chapter considers the various causes of amenorrhea and their treatment. The pathophysiology of amenorrhea in the adolescent. 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. Fetal macrosomia diabetic o th er m anl bsiy pos td aeprg ncy 91. Evaluation and management of primary amenorrhea uptodate. Primary amenorrhoea usually the result of a genetic or anatomical abnormality all causes of secondary amenorrhoea can present as primary nb sheehans causes of primary amenorrhoea cause % chromosomal gonadal dysgenesis 50 hypothalamic hypogonadism 20. Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age. Various factors such as anatomical, genetic and hormonal factors reported to influence pa.
The majority of the causes of primary and secondary. This onepage primer provides useful clinical information on a primary care topic. The cause can be either primary or secondary, while the function refers to the type of. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. However, at age years, if no menses have occurred and there is a complete absence of secondary sexual characteristics such. Complete absence of menstruation in a young woman who is at least 16 years old, or at age 14 with a lack of normal growth or absence of secondary sexual development.
Primary amenorrhea is defined as the absence of menstruation by the age of 16 years in the presence of normal growth and secondary sexual characteristics. Amenorrhea is the absence of a menstrual period in a woman of reproductive age. She underwent thelarche and pubarche at age 14, and was tanner iv breast and pubic hair development. Secondary amenorrhea is the absence of menses for 3 months in a woman with previously normal menses or 9 months in a woman with oligomenorrhea light or. Pdf disruptions in the menstrual cycle are a common complaint in primary care and womens health. Amenorrhea is the term used when a woman or adolescent girl is not having menstrual periods. Amenorrhea is when a girl is not getting her period more to know. The two main disease categories are crohns disease cd and ulcerative colitis uc, which have both overlapping and distinct clinical and pathological features. Although overlapping attributes exist between the two groups, the diagnostic approaches vary significantly. The pathophysiology of amenorrhea in the adolescent neville h. Primary amenorrhea due to hypothalamic disease cancer.
Secondary amenorrhea means you have had periods, and then they stop, especially for more than 3 months. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. Menarche usually occurs at around 12 years of age, within three years of breast development when most girls have tanner breast stage iv. Primary continued uss absent uterus and normal fsh then mullerian agenesis or androgen insensitivity is likely if breasts, normal fsh and uterus then focus on causes of secondary amenorrhoea. Amenorrhea is the medical term for the absence of menstrual periods, either over a permanent or temporary basis. Inflammatory bowel disease ibd is a group of idiopathic chronic inflammatory intestinal conditions. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. Primary amenorrhea is defined as the absence of m en s by wh at g. Treatment of amenorrhea may range from hormonal supplementation for developmental abnormalities of the reproductive system to surgery for tumors of the pituitary.
Case presentation and teaching on primary and secondary amenorrhea. Ppt amenorrhea powerpoint presentation free to view. Primary amenorrhea is the absence of menses by age 16 in the presence of otherwise normal secondary sexual characteristics or by age 14 if secondary sexual development has not occurred. Primary ovarian failure xchromosome abnormality turner syndrome fsh receptor deficiency autoimmune gonadal destruction functional hypothalamic amenorrhea eating disorder, exercise, weight loss stress, chronic illness delayed puberty 20% gonadotropin releasing hormone gnrh deficiency 20% consider mri. A comprehensive guide to hypothalamic amenorrhea recovery and much more, including fertility treatments, pregnancy and postpartum question, and life after recovery.
At age years, if no menses have occurred and there is a complete absence of secondary sexual. Amenorrhea primary and secondary abmormal uterine bleeding has multiple causes. Breast development thelarche should occur by age otherwise, it requires evaluation. Another definition of primary amenorrhea includes girls who have not menstruated within 5 years of breast development. Primary amenorrhea is a delay in or a failure to start menstruation.
What is the difference between primary and secondary. Primary amenorrhea is failure of menses to occur by age 15 years in patients with normal growth and secondary sexual characteristics. Primary amenorrhea, which by definition is failure to reach menarche, is often the result of chromo somal irregularities leading to primary ovarian insufficiency e. Primary amenorrhea an overview sciencedirect topics. It is a rare disorder as over 95% of girls have their first menstrual period by age 15. Treatment options differ for both primary and secondary amenorrhea. Genetic or inborn conditions are the most common causes of primary amenorrhea.
Primary amenorrhea should be considered in any patient with secondary sex characteristics who has not experienced periodic menstruation by 15 years of age or 5 years after breast development. The most common cause of primary amenorrhea is turner syndrome, where one x chromosome is either completely or partially absent. Even if you dont have periods, you could still get pregnant. Background primary amenorrhea is defined as the absence of menses at age 15 years in the presence of normal growth and secondary sexual characteristics. Primary amenorrhea with transverse vaginal septum and scant. Full text full text is available as a scanned copy of the original print version. Links to pubmed are also available for selected references.
Pdf amenorrhea results when the orderly sloughing of the uterine lining on account of the interactions of hormones fails to occur. Current evaluation of amenorrhea the practice committee of the american society for reproductive medicine birmingham, alabama amenorrhea is the absence or abnormal cessation of the menses. If a teenaged girl doesnt get her period by the age of 16, she has primary amenorrhea or absence of menses, which is typically caused by structural or chromosomal abnormalities or functional problems with the hypothalamus or pituitary gland. Primary amenorrhea is the lack of menstr uation by age 16 in the setting of normal development of secondary sexual. Get a printable copy pdf file of the complete article 619k, or click on a page image below to browse page by page. A female patient with primary amenorrhea and sexual development, including pubic hair, should be evaluated for the presence of a uterus and vagina. Pa occurs in % of women in the reproductive age group. Absence of menses for 6 months in a previously menstruating female. Join our community just now to flow with the file primary amenorrhoea and make our shared file collection even more complete and exciting. Feb 26, 2019 there are two main ways to classify amenorrhea, one is by the cause and the other is by the function.
Primary amenorrhea is defined as a failure to reach menarche. Primary amenorrhea signs and symptoms, causes, treatment. Primary amenorrhea is also suspected when a female hasnt had menarche by age and doesnt show signs of puberty, which include developing secondary sexual characteristics like breasts. Primary amenorrhea is an absence of secondary sexual characters until 14 years of age or absence of menstruation with secondary sexual characters until 16 years of age. If amenorrhea happens at other times, it may be the symptom of a treatable medical condition. The identification of primary amenorrhea should always prompt a thorough evaluation to identify a cause. Evaluation of primary amenorrhea differential diagnosis of.
Current evaluation of amenorrhea university of florida. Secondary sexual characteristics and menses in young girls seen in office practice. Evaluation of amenorrhea, anovulation, and abnormal. 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. Primary amenorrhea is defined as the absence of menses at age 15 years in the presence of normal growth and secondary sexual characteristics. The aim of this article is to study the frequency, etiologic causes, presentation, diagnosis, and optimal mode of management of. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she. Amenorrhea free download as powerpoint presentation. Amenorrhea facts amenorrhea refers to the absence of menstrual periods. Causes of primary and secondary amenorrhea health save blog. Amenorrhea gynecology and obstetrics merck manuals.
A free powerpoint ppt presentation displayed as a flash slide show on id. Primary amenorrhea means you never start your periods. Evaluation of primary amenorrhea differential diagnosis. Primary amenorrhea with transverse vaginal septum and. Primary amenorrhea is the absence of a first period in a young woman by the age of 16. Learn vocabulary, terms, and more with flashcards, games, and other study tools. However, at age years, if no menses have occurred and there is a complete absence of secondary sexual characteristics such as breast development. Amenorrhea means you do not have menstrual periods. Primary amenorrhea definition of primary amenorrhea by. Primary amenorrhea is defined as failure to reach menarche. If arup consult does not answer your test selection and interpretation questions, or if youd like to suggest ways to improve content or usability, please leave a message for the arup clinical content team. Primary amenorrhea article about primary amenorrhea by the.
It also considers the diagnosis and treatment of abnormal uterine bleeding at all stages of life. A proposal document of the japan society of obstetrics and gynecology committee for the redefinition of primary amenorrhea. A 17yearold nulligravid female presented to the adolescent gynecology clinic for primary amenorrhea. Michael evans developed the onepager concept to provide clinicians with useful clinical information on primary care topics. The identification of primary amenorrhea should always prompt a thorough evaluation to identify a cause 1. Primary amenorrhea is defined as absence of menstruation by age 16 90. In contrast, prolonged amenorrhea might be the earliest sign of a decline in general health or signal an underlying condition. Primary amenorrhea pa is defined by the absence of attainment of menarche by the age of 1618 years. 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. Renee andreeff is an academic coordinator and a clinical assistant professor in the pa program at dyouville college in buffalo, n. Amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus, pituitary, ovaries. There are many causes of primary amenorrhea, and depending on the cause, it may affect clinical presentation e. Amenorrhea not due to pregnancy, lactation, or menopause is a relatively common abnormality of the reproductive years and indicative of a defect somewhere in the hypothalamicpituitaryovarianuterine axis.