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Epidemiology and causes of secondary amenorrhea

Corrine K Welt, MD
Robert L Barbieri, MD
Section Editors
William F Crowley, Jr, MD
Mitchell E Geffner, MD
Deputy Editor
Kathryn A Martin, MD


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. An intermenstrual interval greater than 45 days is considered abnormal in adolescent girls who are ≥2 years postmenarche [1]. 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 [2]:

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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Literature review current through: Dec 2017. | This topic last updated: Dec 04, 2017.
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