Secondary amenorrhea testing algorithm arup consult. Disruptions in the menstrual cycle are a common complaint in primary care and womens health. Oct 14, 2019 treatment is determined by the etiology of the amenorrhea and the desires of the patient. Evaluation of amenorrhea, anovulation, and abnormal. Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Secondary amenorrhea is defined as the absence of menstrual flow in women with previously normal menstruation. Amenorrhea in teens health encyclopedia university of. Secondary amenorrhea after hodgkins lymphoma is in.
Inpatient treatment is recommended for hypothalamic amenorrhea patients who have severe bradycardia, hypotension, orthostasis, andor electrolyte imbalance. Most cases of secondary amenorrhea can be attributed to polycystic. 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 months in girls or women. This fact sheet focuses on secondary amenorrhea that is not due to pregnancy. Secondary amenorrhea develops when a female with normal menstrual cycle stops having her periods for more than six months. An absence of menstruation for at least half a year or three consecutive periods in women who had normal menstrual periods before this is termed secondary amenorrhea.
Diagnostic approach and treatment considerations article pdf available in the nurse practitioner 429. Ideally, treatment should be directed at correcting the underlying pathology. Most cases of secondary amenorrhea can be attributed to. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. We go over the definition of amenorrhea, causes, and. If lack of menstruation is not caused by pregnancy, menopause or breastfeeding, it is most likely that secondary amenorrhea is present. The treatment depends on the cause of your amenorrhea. Outside the reproductive years, there is absence of menses during childhood and after.
Secondary amenorrhea american academy of pediatrics. Oct 14, 2019 inpatient treatment is recommended for hypothalamic amenorrhea patients who have severe bradycardia, hypotension, orthostasis, andor electrolyte imbalance. Treatment goals include prevention of complications such as osteoporosis, endo. Amenorrhea is when a girls menstrual bleeding period doesnt occur. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. This article discusses secondary amenorrhea and provides a systematic approach to its diagnostic evaluation, with referral considerations. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. Secondary amenorrhea can occur due to natural changes in the body. Medical causes of secondary amenorrhea may include pcos, hypothalamic. Jun 04, 2019 amenorrhea is a condition characterized by complete stoppage or missing of menstrual periods 1. Despite the low prevalence of secondary amenorrhea, a prompt, comprehensive assessment is warranted unless the patient is pregnant, lactating, or using hormonal contraceptives, as amenorrhea is often the presenting sign of an underlying reproductive disorder. Treatment for secondary amenorrhea, depending on the cause, may include medical or surgical treatments or a combination of the two. The epidemiology and causes of secondary amenorrhea and overviews of primary amenorrhea and abnormal uterine bleeding in adolescents are discussed separately. Primary amenorrhea occurs when a girl has not had her first period by age 16.
The gynecologic age, the time in months since menarche, is the best indicator that a normal ovulatory pattern should have been established. Secondary amenorrhea is due to pregnancy, stress, illness or other causes. Secondary amenorrhea is an absence of menstruation for greater than or equal to three months. The pathophysiology of amenorrhea in the adolescent. This is when the first menstrual bleeding at puberty doesnt occur by age 15. Jul 25, 2019 treatment depends on the underlying cause of your amenorrhea. Because of the high mortality rate associated with eating disorders, and especially anorexia nervosa, careful monitoring is recommended in extremely low weight patients.
Causes of primary and secondary amenorrhoea can overlap think from the top down common things are common. Celiac disease adapted from etiology, diagnosis and treatment of secondary amenorrhea, uptodate 2010. Primary amenorrhea is due to changes in organs, glands, and hormones related to menstruation. Evaluation of secondary amenorrhea differential diagnosis. Primary or secondary amenorrhea typically occurs in women with. If primary or secondary amenorrhea is caused by lifestyle factors, your health care provider may suggest changes in the areas below. Even if you dont have periods, you could still get pregnant. 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. Dysfunction of the hpo axis hypothalamic dysfunction functional hypothalamic amenorrhea inflammatory or infiltrative diseases of the hypothalamus lymphoma, langerhans cell histiocytosis, sarcoidosis systemic disease e. Traditionally this term has only been used in those with amenorrhea of greater than 3months duration. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Hormonal imbalances can be treated with supplemental or synthetic hormones.
Postpill amenorrhea is, in most cases, a relatively uncomplicated medical problem to diagnose and treat, but it is imperative to exclude pituitary tumors or serious endocrinological abnormalities before treatment is begun. Irregular or absent menstrual periods should trigger an evaluation to identify the root cause. 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. This may be because of a physical cause, and usually happens. The treatment of primary and secondary amenorrhea is based on the causative factor. Secondary amenorrhea testing algorithm arupconsult. Secondary amenorrhea north dakota department of health. More research is needed on novel treatments in order to determine the most effective standard. The distinction between primary amenorrhea and secondary amenorrhea is somewhat arbitrary and thereisagreatdealofoverlap. Mar 30, 2019 common causes of secondary amenorrhea when a woman who has had normal periods stops getting them include. Primary amenorrhea means you never start your periods. Treatment depends on the diagnosis irrespective of the diagnosis 46xo, pof etc many common issues related to permanent loss of ovarian function. Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who havent begun menstruation by age 15.
Treatment options range from estrogenreplacement therapy to the administration of gonadotropin releasing hormone, depending on the reproductive goals of the woman. Extreme weight gain or loss, certain medications, as well as anxiety can be the root cause of amenorrhea. Treatment may be done with hormones or other medicines, changes in diet or exercise, and calcium supplements. It also considers the diagnosis and treatment of abnormal uterine bleeding at all. 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. Secondary amenorrhea is defined as the absence of menstruation for at least three cycles or at least 6 months in females who have already established menstruation. Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age. Details on treatments and causes of amenorrhea the absence of a monthly period are provided. Amenorrhea has many causes, including hormone problems, eating habits and exercise, or a birth defect. 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. Amenorrhea means you do not have menstrual periods. 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. Treatment is determined by the etiology of the amenorrhea and the desires of the patient. Common medical treatments for secondary amenorrhea include.
Pdf disruptions in the menstrual cycle are a common complaint in primary care and womens health. Treatment options differ for both primary and secondary amenorrhea. Secondary and primary amenorrhea definition, causes, treatment. Amenorrhea uhmenoreeuh is the absence of menstruation one or more missed menstrual periods. Functional hypothalamic amenorrhea is associated with stress, weight loss, or exercise or a combination but the diagnosis requires ruling out organic or anatomic causes of anovulation. It also considers the diagnosis and treatment of abnormal uterine bleeding at all stages of life. It is helpful to divide the evaluation of amenorrhea into three categories. Amenorrhea is not a disease, but it can be a symptom of another condition. Among the causes of secondary amenorrhea are hypothyroidism, premature. It also considers the diagnosis and treatment of abnormal uterine. Secondary amenorrhea testing indications for testing amenorrhea with negative pregnancy test order prolactin luteinizing hormone and follicle stimulating hormone.
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. Evaluation of amenorrhea, anovulation, and abnormal bleeding. Treatment depends on the underlying cause of your amenorrhea. Describe the classification of amenorrhea and list the major causes of primary and secondary amenorrhea. A new endocrine society guideline recommends a multidisciplinary approach to treatment of fha, including medical, dietary, and mental health support. Secondary amenorrhea is characterized by a cessation of the menstrual period for six months or more. Once pregnancy has been ruled out, a logical approach to women with either primary or secondary amenorrhea is to consider disorders based upon the levels of control of the menstrual cycle. Secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence of pregnancy, breastfeeding or menopause.
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. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. Secondary amenorrhea is defined as the cessation of regular menses for three months or the ces sation of irregular menses for six months. An ayurvedic approach to the treatment of secondary. Amenorrhea is a condition characterized by complete stoppage or missing of menstrual periods 1. Secondary amenorrhea occurs when you miss your period for six months or longer. Treatment options will depend on medical history, contraceptive history, desire. If a tumor or structural blockage is causing the problem, surgery may be necessary. Secondary amenorrhea means you have had periods, and then they stop, especially for more than 3 months. See causes of primary amenorrhea and epidemiology and causes of secondary amenorrhea and evaluation and management of secondary.
The most common etiologies are pregnancy and polycystic ovarian syndrome pcos. There are two types of amenorrhea primary or secondary. Evaluation and management of secondary amenorrhea uptodate. Among the causes of secondary amenorrhea are hypothyroidism, premature ovarian failure, obesity and the effects of some drugs such as birth control pills. In some cases, contraceptive pills or other hormone therapies can restart your menstrual cycles. Treatment for secondary amenorrhea depends on the causes. The treatment for amenorrhea depends on the underlying cause, as well as the health status and goals of the individual.
Treating secondary amenorrhea generally varies depending on the underlying cause of. 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. Treatment goals for patients with amenorrhea may vary considerably. Diagnost ic approach and treatment considerations stimulation, or medications, magnetic resonance imaging mri of the pituitary gland should be done to assess for a. Birth control pills or other types of hormonal medication. All causes of secondary amenorrhoea can present as primary nb sheehans causes of primary amenorrhoea cause %. See epidemiology and causes of secondary amenorrhea and evaluation and management of. Charlotte amenorrhea treatment holistic wellness center. 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. Secondary amenorrhea is amenorrhea in a patient who has already established regular menstrual cycles. Functional hypothalamic amenorrhea treatment guidelines. The menstrual flow must have ceased for a minimum of 3 months for diagnosis to be made or 9 months if the patient has a history of oligomenorrhea. In this kind of amenorrhea, normal during lactation or pregnancy a womans periods commence and then cease to occur.
Secondary amenorrhea describes women who experience an absence of more than three. A delay in diagnosis and treatment may adversely impact the future of such patients. A report from the german hodgkins lymphoma study group karolin behringer, kai breuer, thorsten reineke, michael may, lucia nogova, beate klimm. Missing several menstrual periods in a row is the primary symptom of secondary amenorrhea. Learn more about the several treatment options for secondary amenorrhea and the side effects of each treatment. Amenorrhea pronounced eymenuhreeuh or uhmenuhreeuh is the medical term for the lack of a menstrual period. This chapter considers the various causes of amenorrhea and their treatment. 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. The treatment of primary and secondary amenorrhea is based on the. Breastfeeding and menopause are also common, but natural, causes.
Hypothalamic amenorrhea ha is a form of secondary amenorrhea that affects 35% of. In the case of outflow tract abnormalities eg, imperforate hymen, surgery may be indicated. The etiology, diagnosis, and treatment of secondary amenorrhea are discussed separately. The treatment for secondary amenorrhea varies depending on the underlying cause of your condition. Your teen may need blood tests and a pelvic ultrasound. Definition amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus, pituitary, ovaries, uterus, or vagina. It is often classified as either primary absence of menarche by. This is when normal menstrual bleeding stops occurring for 3 months or more. For example, the most common cause of secondary amenorrhea is pregnancy.
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