Mar 07, 2018 treatment of primary amenorrhea general characteristics of secondary amenorrhea historical findings in girls with secondary amenorrhea physical exam findings in girls with secondary amenorrhea. Evaluation of amenorrhea, anovulation, and abnormal. Oct 14, 2019 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. Secondary sexual characteristics and menses in young girls seen in office practice. Abdominal and rectal examination with little finger to perform the bimanual examination. Lack of any secondary sexual characteristics by age years also is abnormal and should be investigated. Amenorrhea is defined as the absence or abnormal cessation of menstruation in women of reproductive age and can be divided into primary and secondary amenorrhea 1,2. Careful history and physical examination are crucial to diagnosis. In order to exclude organic diseases of the hypothalamic area, including but not limited to neoplasms, sarcoidosis, tuberculosis, and parasitoids. Underlying conditions may overlap in primary and secondary amenorrhea. Serum prolactin and thyrotropin tsh levels were elevated. Imperforate hymen seen on external genital examination. It also considers the diagnosis and treatment of abnormal uterine bleeding at all stages of life. It is a rare disorder as over 95% of girls have their first menstrual period by age 15.
Choose when to start an evaluation for secondary amenorrhea2. Causes of primary and secondary amenorrhea health save blog. The epidemiology and causes of secondary amenorrhea and overviews of primary amenorrhea and abnormal uterine bleeding in adolescents are. Secondary and primary amenorrhea definition, causes, treatment. Amenorrhea differential diagnoses medscape reference. Patients and methods all women with primary or secondary amenorrhoea who were referred to the clinical genetic service of the department of health from 1 january 1991 to 30 april 2002 were recruited. T1 risk factors for secondary amenorrhea and galactorrhea. Treatment options differ for both primary and secondary amenorrhea.
The etiologic and diagnostic considerations for oligomenorrhea are the same as for secondary amenorrhea. Magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Chromosomal or genetic abnormalities can cause the ovaries to stop functioning normally. 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. If primary or secondary amenorrhea is caused by lifestyle factors, your health care provider may suggest changes in the areas below. Find out about the causes of amenorrhea, when to see a doctor, and what treatment is available. Turner syndrome, a condition caused by a partially or completely missing x chromosome, and androgen insensitivity syndrome, often characterized by high levels of. Amenorrhea is the absence or abnormal cessation of the menses 1 x 1 in.
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. Secondary amenorrhea testing algorithm arupconsult. Evaluation of amenorrhea, anovulation, and abnormal bleeding. An initial secondary amenorrhea workup includes thyroid stimulating hormone tsh, prolactin, follicle stimulating hormone fsh, and luteinizing hormone. Secondary amenorrhea testing algorithm arup consult. Secondary amenorrhea is present when a young woman ceases to menstruate after she has had one or more menstrual periods. Primary amenorrhea means you never start your periods.
Treatment of primary amenorrhea general characteristics of secondary amenorrhea historical findings in girls with secondary amenorrhea physical exam findings in girls with secondary amenorrhea. Nov 30, 2015 magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. This chapter considers the various causes of amenorrhea and their treatment. Oct 14, 2019 amenorrhea can be due to pregnancy, anatomic defects of the outflow tract, ovarian disorders, and pituitary or hypothalamic disorders.
Evaluation of primary amenorrhea differential diagnosis of. Secondary amenorrhea is defined as the cessation of regular menses for three months or the ces sation of irregular menses for six months. Secondary amenorrhoea is defined as the cessation of menstruation for six consecutive months in a woman who has previously regular periods. Primary amenorrhea is the lack of menstr uation by age 16 in the setting of normal development of secondary sexual. Secondary amenorrhea is defined as the absence of menstrual flow in women with previously normal menstruation. Amenorrhea pediatrics clerkship the university of chicago. Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Amenorrhea is defined secondary when menstrual cycles disappear for 6 consecutive months in a girl with irregular menses or for 3. Primary amenorrhoea was defined as the absence of menstruation and secondary. Most cases of secondary amenorrhea can be attributed to. The pathophysiology of amenorrhea in the adolescent. Table 43,6,15 includes the differential diagnosis of primary. Secondary amenorrhea, the cessation of previously normal menstruation, should be considered in any female who has a gynecologic age of at least 24 months and has not menstruated for three or more consecutive cycles.
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. Primary amenorrhea can be diag nosed if a patient has normal sec ondary sexual characteristics but no menarche by 16 years of age. 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. Amenorrhea is classified as primary and secondary according to its occurrence before or after menarche, respectively the practice co mmittee of american society for. It is often classified as either primary absence of menarche by age 15 years or secondary absence of menses for more than three months in. Jan 15, 2018 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.
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. Primary and secondary amenorrhea flashcards quizlet. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. This article discusses secondary amenorrhea and provides a systematic approach to its diagnostic evaluation, with referral considerations. Primary amenorrhea is the absence of a first period in a young woman by the age of 16. Evaluation of primary amenorrhea differential diagnosis.
However if patients have had no menstrual periods by age and have no signs of puberty eg, any type of breast development, they should be evaluated for primary amenorrhea. There are two types of amenorrhea primary or secondary. Up to 50% of competitive runners training 80 miles per week and up to 44% of ballet dancers have amenorrhea. If amenorrhea happens at other times, it may be the symptom of a treatable medical condition. It is often classified as either primary absence of menarche by age 15 years or thereafter or secondary absence of menses for more than three. Causes of secondary amenorrhea can also result in primary amenorrhea, especially if present before onset of menarche. Disruptions in the menstrual cycle are a common complaint in primary care and womens health. Other forms of primary and secondary amenorrhea should be distinguished from fha, including genetic causes such as kallman syndrome and praderwilli syndrome caronia et al. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respec tively. Elicit a pertinent history to evaluate amenorrhea and list the essential elements of a focused physical. The treatment for amenorrhea depends on the underlying cause, as well as the health status and goals of the individual.
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. Timing of the evaluation of primary amenorrhea recognizes the trend to earlier age at. Primary amenorrhea is failure of menses to occur by age 15 years in patients with normal growth and secondary sexual characteristics. Over 50% of cases of secondary amenorrhea result from perturbations in the hypothalamicpituitaryadrenal hpa axis. Amenorrhea is the transient or permanent absence of menstrual flow and may be subdivided into primary and secondary presentations, relative to menarche.
When a women presents and reports menstrual irregularity with amenorrhea, which is the most common cause of amenorrhea. Menstrual disorders american academy of pediatrics. Many adult women are happy to forgo the inconvenience of a monthly period. Amenorrhea the lack of menstruation is a symptom, not a disease unto itself, and may be divided into primary delayed menarche or secondary amenorrhea cessation of menses in someone who has previously menstruated. Risk factors for secondary amenorrhea and galactorrhea uc davis. Gonadal dysgenesis, including turner syndrome 43 percent. Pdf on oct 26, 2011, valentina chiavaroli and others published primary and secondary amenorrhea find, read and cite all the research you need on.
After initiation of thyroid hormone replacement, serum tsh and prolactin levels fell progressively. Amenorrhea is defined primary when menarche does not occur by the age of 16 years in a girl with complete secondary sexual development, or by the age of 14 years in a girl without secondary sexual development. Menarche usually occurs at around 12 years of age, within three years of breast development when most girls have tanner breast stage iv. Primary amenorrhea is usually the result of a genetic or anatomical abnormality. The pathophysiology of amenorrhea in the adolescent neville h. Amenorrhea is the medical term for the absence of menstrual periods, either over a permanent or temporary basis. Amenorrhea in adolescents newbery pediatric medicine. Secondary amenorrhoea absence of menses for more than three cycles or 6 months in women who previously had menses. Amenorrhea is the absence of a menstruation during the reproductive years.
Current evaluation of amenorrhea fertility and sterility. Secondary amenorrhea testing indications for testing amenorrhea with negative pregnancy test order prolactin luteinizing hormone and follicle stimulating hormone. No period by age 16 with secondary sexual characteristics. Pdf primary and secondary amenorrhea semantic scholar. After completing this activity, the participant should be better able to.
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. Primary hypothyroidism, amenorrhea, and galactorrhea. Definition when menstruation has previously occurred but it has stopped for at least 6 consecutive months consider the cause of the amenorrhoea to guide appropriate referral eg endocrinology infertility or pcos service general gynae eating disorders service. Details on treatments and causes of amenorrhea the absence of a monthly period are provided. Being overweight or severely underweight can affect your menstrual cycle. Amenorrhea means you do not have menstrual periods. However, all causes of secondary amenorrhea can also present as primary amenorrhea. In a large case series of primary amenorrhea, the most common etiologies were 2. Diagnostic testspregnancy test betahcg in urine or serum. Primary amenorrhea signs and symptoms, causes, treatment.
Secondary amenorrhea american academy of pediatrics. The cessation of menstruation for abnormal reasons. Evaluation and management of primary amenorrhea uptodate. Epidemiology and causes of secondary amenorrhea uptodate. This is when a female fails to begin her monthly menstrual cycle by the age of 16. Diagnosis is clinical when the patient meets the definition of primary amenorrhea. Primary or secondary amenorrhea typically occurs in women with deletions in either the short or the long arm of one x chromosome. Irregular or absent menstrual periods should trigger an evaluation to identify the root cause. A thorough history and physical examination should be the first step in the primary amenorrhea workup 4. Get a printable copy pdf file of the complete article 619k, or click on a page image below to browse page by page. Primary amenorrhea occurs when a girl has not had her first period by age 16.
However, patients with previously regular cycles are evaluated for secondary amenorrhea if menses have been absent for. Another definition of primary amenorrhea includes girls who have not menstruated within 5 years of breast development. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. A 30yearold woman had galactorrhea and secondary amenorrhea, along with symptoms, signs, and laboratory findings of primary hypothyroidism. This fact sheet focuses on secondary amenorrhea that is not. Pdf primary amenorrhoea is a symptom with an extensive list of underlying causes, the majority of which are rare. Evaluation and management of secondary amenorrhea uptodate. Secondary amenorrhea occurs when youve had at least one menstrual period and you stop menstruating for three months or longer. Even if you dont have periods, you could still get pregnant. Amenorrhea primary and secondary abmormal uterine bleeding has multiple causes. Anovulation a teenage patient presents with amenorrhea and normal secondary sex.
Evaluation for primary amenorrhea should begin in any patient years of age with no menses and with complete absence of secondary sex. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. Secondary amenorrhea means you have had periods, and then they stop, especially for more than 3 months. Breast development thelarche should occur by age otherwise, it requires evaluation. 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. In some cases, the cause is functional, meaning that the hypothalamic gonadotropinreleasing hormone gnrh pulse generator has shut down the reproductive system in its role as an integrator of metabolic and psychogenic stress. Initial workup of primary and secondary amenorrhea includes a pregnancy test and serum lev els of luteinizing hormone, folliclestimulating. Learning objectives and cmedisclosure information this activity is intended for healthcare providers delivering care to women and their families. Primary amenorrhea failure of menses to occur by age 16 can result from two main causes. 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. Because only 3 diagnoses are unique to primary amenorrhea and never cause secondary amenorrhea, differentiating primary from secondary amenorrhea does little to enhance the clinicians understanding of the etiology. Secondary amenorrhea is a condition when period cycle of women with irregular menstruation disappeared within six months in a row or. Primary amenorrhea is due to changes in organs, glands, and hormones related to menstruation. Primary amenorrhoea can be diagnosed in female children by age 14 if no secondary sex characteristics, such as enlarged breasts and body hair, are present.
Neuroendocrine causes of amenorrheaan update the journal. Nr 602 week 7 quiz topics questions with answers 1 week 7. No period by age 14 without secondary sexual characteristics. Insert nasal speculum to perform vaginal and cervical inspection. List the most common causes of secondary amenorrhea in women of reproductive age estimated time. Primary amenorrhea with secondary sexual characteristics. The differential diagnosis of primary amenorrhea encompasses that of secondary amenorrhea and includes pregnancy, hyperprolactinemia, thyroid dysfunction, hypothalamicpituitary dysfunction, primary ovarian insufficiency related to chromosomal abnormalities, and polycystic ovarian syndrome.
Causes of primary amenorrhea should be evaluated in the context of the presence or absence of secondary sexual characteristics. Primary amenorrhea is defined as a failure to reach menarche. 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. N2 objective analyses were undertaken to identify factors that may predispose women to secondary amenorrhea or galactorrhea, frequent sources of abnormal reproductive function. 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. Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age. Evaluation of a patient with primary amenorrhea should include a vaginal exam, uterine assessment, serum. The causes of primary and secondary amenorrhea are quite.
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