The menstrual cycle is susceptible to outside influences. The outlook depends on the cause of the amenorrhea and whether it can be corrected with treatment or lifestyle changes. Klein, md, mph, san antonio military medical center, san antonio, texas merrily a. Primary amenorrhea no menses by age 14 without breast development. An initial secondary amenorrhea workup includes thyroid stimulating hormone tsh, prolactin, follicle stimulating hormone fsh, and luteinizing hormone. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Birth control pills may prevent your period from starting for a few months after you stop taking them. List the most common causes of secondary amenorrhea in women of reproductive age estimated time. Current evaluation of amenorrhea fertility and sterility. It is often classified as either primary absence of menarche by age 15 years or secondary absence of menses for more than three cycle intervals or. With the technical assistance of bente mpller amenorrhea, which may be defined as the absence of menstruation, can be classified in several ways, e.
If a patient has no secondary sexual character istics and no menarche, primary amenor rhea can be diagnosed as early as 14 years of age. Primary amenorrhea signs and symptoms, causes, treatment. Amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina. 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. Background primary amenorrhea is defined as the absence of menses at age 15 years in the presence of normal growth and secondary sexual characteristics. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. After completing this activity, the participant should be better able to. Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Amenorrhoea is the absence of menses in a woman of reproductive age.
Amenorrhea differential diagnoses medscape reference. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. Indications for testing lack of menstrual flow by age 14 and absence of secondary sexual characteristics or lack of menstrual flow by age 16 and presence of secondary sexual characteristics physical and pelvic examination may also consider pelvic ultrasound if unable to confirm presence of uterus. Microsoft edge is the default program for opening pdf files on windows 10.
Amenorrhea is the absence or abnormal cessation of the menses physiologial amenorrhea pathologial amenorrhea 3. A 15yearold adolescent was raised according to female gender. It is caused by dysfunctioning of the pituitary gland, ovaries, uterus, and hypothalamus, by surgical removal of the ovaries. A comprehensive guide to hypothalamic amenorrhea recovery and much more, including fertility treatments, pregnancy and postpartum question, and life after recovery. Pdf primary amenorrhoea is a symptom with an extensive list of underlying causes, the majority of which are rare.
The most common etiologies are pregnancy and polycystic ovarian syndrome pcos. Amenorrhea, the absence of menstrual bleeding, can be either primary or secondary. Primary amenorrhea is the lack of menses by age 15 with secondary sex characteristics, or at with absence of secondary sex characteristics 1,2. 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. Secondary amenorrhea occurs when youve had at least one menstrual period and you stop menstruating for three months or longer. The aim of this article is to study the frequency, etiologic causes, presentation, diagnosis, and optimal mode of management of. Primary amenorrhea is the absence of the menstrual period by the age of 16.
Amenorrhea is the absence of menstrual bleeding and may be primary or secondary primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics for example, breast development and pubic hair in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. This may appear as primary amenorrhea, which is the lack of menstruation before age 16. Secondary amenorrhea is defined as the absence of menstrual flow in women with previously normal menstruation. Secondary amenorrhoea is absence of periods for at. Amenorrhea gynecology and obstetrics merck manuals. Primary amenorrhea that is caused by tumors, weight problems, malnutrition, hormonal issues, reproductive malformation, and some longterm illnesses can be cured once the underlying condition is eliminated.
Secondary and primary amenorrhea definition, causes, treatment. 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. Magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Choose when to start an evaluation for secondary amenorrhea2. Pdf on oct 26, 2011, valentina chiavaroli and others published primary and secondary amenorrhea find, read and cite all the research you need on.
Secondary amenorrhea is defined as the cessation of menstruation for at least 6 months or for at least 3 of the previous 3 cycle intervals. Treatment options differ for both primary and secondary amenorrhea. Amenorrhea american academy of pediatrics textbook of. Amenorrhea may be a sign of a serious medical problem that needs to be treated. Secondary amenorrhea testing algorithm arup consult. Associate pdf files to always open in reader or acrobat on. Up to 50% of competitive runners training 80 miles per week and up to 44% of ballet dancers have amenorrhea. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. In four easy steps, you can make acrobat dc or acrobat reader dc your default pdf program. Primary amenorrhea a study of 101 cases john philip, m. Your period may stop while you are breastfeeding or under more stress than usual. Pcos 20% of all cases of amenorrhoea can be primary, but usually a normal or slightly delayed menarche followed by.
Timing of the evaluation of primary amenorrhea recognizes the trend to earlier age. If amenorrhea happens at other times, it may be the symptom of a treatable medical condition. Primary amenorrhea is the absence of a first period in a young woman by the age of 16. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. This patient exhibited normal female external physical characteristics with a shallow, blind vaginal pouch upon examination. Recent reflections david a grainger md, mph february 1, 2017. Depending on the cause of primary amenorrhea, a cure may be possible. Primary amenorrhea, puberty, breast development, mullerian structures. Various etiologies of primary amenorrhea include outflow tract obstructions, gonadal dysgenesis, abnormalities of the central nervous system. 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. Amenorrhea is characterized by a complete lack of menstrual cycles. Primary amenorrhea with transverse vaginal septum and. The family history was negative, nonconsanguineous parents. However, patients with previously regular cycles are evaluated for secondary amenorrhea if menses have been absent for.
Periods are not likely to start on their own if the amenorrhea was caused by one of the following conditions. Get a printable copy pdf file of the complete article 619k, or click on a page image below to browse page by page. Initial workup of primary and secondary amenorrhea includes a pregnancy test and serum lev els of luteinizing hormone, folliclestimulating hormone, prolactin, and thyroidstimulating hormone. Primary amenorrhea is defined as the failure to initiate menstruation, whereas secondary amenorrhea refers to cessation of menses in an adolescent who has previously menstruated. The majority of the causes of primary and secondary amenorrhea are similar. Evaluation of primary amenorrhea differential diagnosis. 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. Secondary sexual characteristics and menses in young girls seen in office practice. Primary amenorrhea testing indications for testing lack of menstrual flow by age 14 and absence of secondary sexual characteristics or lack of menstrual flow by age. Jacobson, md, professor of obstetrics and gynecology, loma linda. Primary amenorrhea, a rare disorder that occurs in 1% to 2% of women, is the absence of menstrual bleeding by age 16 in women who exhibit signs of secondary.
Lack of menstrual flow by age 14 and absence of secondary sexual characteristics or lack of. Treatment of amenorrhea may range from hormonal supplementation for developmental abnormalities of the reproductive system to surgery for tumors of the pituitary. Craniopharyngioma a tumor near the pituitary gland at the base of the brain. Evaluation and management of amenorrhea related to congenital. Causes of primary amenorrhea should be evaluated in the context of the presence or absence of secondary sexual characteristics. Oestrogendeficient amenorrhea is associated with reduced bone mineral density and increased fracture risk, while oestrogenreplete amenorrhea can lead to dysfunctional. How to make acrobat reader dc or acrobat dc your default pdf program watch a short video tutorial below on how to set acrobat reader.
Primary and secondary amenorrhea flashcards quizlet. Primary amenorrhea definition of primary amenorrhea by. Primary amenorrhea is a delay in or a failure to start menstruation. Learning objectives and cmedisclosure information this activity is intended for healthcare providers delivering care to women and their families. Primary amenorrhoea may be defined as the absence of menses and secondary sexual characteristics by age 14, or the absence of menses regardless. Amenorrhea is the transient or permanent absence of menstrual flow and may be subdivided into primary and secondary presentations, relative to menarche.
Table 43,6,15 includes the differential diagnosis of primary. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. Amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina table 1 and table 2. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Secondary amenorrhea occurs in women who have had normal menstrual cycles that have stopped for six months or more. It is a rare disorder as over 95% of girls have their first menstrual period by age 15. Classification of amenorrhea prepuberty pregnancy related menopause primary secondary amenorrhea physiological pathological 5. 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. Primary amenorrhea normal secondary sexual development blind. At puberty the adolescent had primary amenorrhea and a severe virilization with deep voice, masculine muscular development, increased growth of body, and facial hair.
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