Epidemiology and causes of secondary amenorrhea
- Corrine K Welt, MD
Corrine K Welt, MD
- Professor of Medicine
- University of Utah School of Medicine
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Section Editors
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K Podolsky Professor of Medicine
- Harvard Medical School
- Mitchell Geffner, MD
Mitchell Geffner, MD
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Keck School of Medicine, University of Southern California
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). 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 girls or women who previously had regular menstrual cycles or six months in girls or women who had irregular menses). Missing a single menstrual period may not be important to assess, but amenorrhea lasting three months or more and oligomenorrhea (fewer than nine menstrual cycles per year or cycle length greater than 35 days) require investigation. The etiologic and diagnostic considerations for oligomenorrhea are the same as for secondary amenorrhea.
The epidemiology and causes of secondary amenorrhea are reviewed here. The evaluation and management of secondary amenorrhea and the causes, evaluation, and management of primary amenorrhea are discussed separately. (See "Evaluation and management of secondary amenorrhea" and "Causes of primary amenorrhea" and "Evaluation and management of primary amenorrhea".)
The most common causes of secondary amenorrhea, based upon a series of 262 patients with amenorrhea of adult onset, include :
●Hypothalamus – 35 percent (almost all functional hypothalamic amenorrhea) (see 'Functional hypothalamic amenorrhea' below)
●Pituitary – 17 percent (13 percent hyperprolactinemia, 1.5 percent “empty sella,” 1.5 percent Sheehan syndrome, 1 percent Cushing’s syndrome) (see 'Pituitary disease' below)
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- Hypothalamic dysfunction
- - Functional hypothalamic amenorrhea
- Risk factors
- Role of leptin deficiency
- Genetic basis
- - Hypothalamic tumors and infiltrative lesions
- - Systemic illness
- Type 1 diabetes mellitus
- Celiac disease
- Pituitary disease
- - Hyperprolactinemia
- - Other sellar masses
- - Other diseases of the pituitary
- Thyroid disease
- Polycystic ovary syndrome
- - Other hyperandrogenic disorders
- Ovarian disorders
- - Primary ovarian insufficiency (premature ovarian failure)
- - Ovarian tumors
- Uterine disorders