Amenorrhea history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

The hallmark of primary amenorrhea is absence of menarche until 15 years of age, in the presence of other secondary sexual characteristics; or lack of menarche after 5 years of thelarche, if thelarche occurred before 10 years of age. The hallmark of secondary amenorrhea is menstrual cycle interruption for at least 3 months, however were regular before; or menstrual cycle interruption for at least 6 months, however were irregular before.

History and Symptoms

The hallmark of primary amenorrhea is:
- Absence of menarche until 15 years of age, in the presence of other secondary sexual characteristics.
- Absence of menarche after 5 years of thelarche, if thelarche occurred before 10 years of age.^[1]

The hallmark of secondary amenorrhea is:
- Menstrual cycle is interrupted for at least 3 months, however were regular before.^[2]
- Menstrual cycle is interrupted for at least 6 months, however were irregular before.^[3]

Patients history and symptoms that are suggestive of different causes of amenorrhea are as following table:^[4]^[5]

Groups	Elements		Underlying cause of amenorrhea
Patient history	Stress		Functional amenorrhea
	Exercise
	Weight loss
	Chronic illness	Crohn disease
		Cystic fibrosis
		Sickle cell disease
		Thalassemia major
	Illicit drug use	Alcohol
		Cocaine
		Marijuana
		Opioids
	Lack of menarche		Primary amenorrhea
	Menstrual history		Secondary amenorrhea
	Prescription drug use	Androgens	Multiple, depending on medication
		Antidepressants
		Danazol
		High-dose progestins
	Previous central nervous system chemotherapy or radiation		Hypothalamic amenorrhea
	Previous pelvic radiation		Premature ovarian failure
	Psychosocial stressors		Anorexia or bulimia nervosa
	Nutritional problems
	Exercise history
	Sexual activity		Pregnancy
Family history	Genetic defects	Congenital gonadotropin-releasing hormone deficiency	Multiple causes of primary amenorrhea
		GnRH receptor gene mutations
		Prader-Willi syndrome
		Congenital thymic aplasia
		Fragile X syndrome
		Idiopathic accelerated ovarian follicular atresia
	Pubic hair pattern		Androgen insensitivity syndrome
	Infertility		Multiple causes of primary amenorrhea
	Menarche and menstrual history (mother and sisters)		Constitutional delay of growth and puberty
	Pubertal history (e.g., growth delay)		Constitutional delay of growth and puberty
Review of systems	Anosmia		Kallmann syndrome
	Cyclic abdominal pain		Outflow tract obstruction or müllerian agenesis
	Breast changes		Outflow tract obstruction or müllerian agenesis
	Galactorrhea		Pituitary tumor
	Headache
	Visual disturbances
	Hirsutism		Polycystic ovary syndrome
	Acne		Polycystic ovary syndrome
	Signs and symptoms of hypothyroidism or hyperthyroidism	Temperature intolerance	Thyroid disease
		Palpitations
		Diarrhea
		Constipation
		Tremor
		Depression
		Skin changes
	Vasomotor symptoms		Premature ovarian failure

References

↑ Herman-Giddens, M. E.; Slora, E. J.; Wasserman, R. C.; Bourdony, C. J.; Bhapkar, M. V.; Koch, G. G.; Hasemeier, C. M. (1997). “Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network”. PEDIATRICS. 99 (4): 505–512. doi:10.1542/peds.99.4.505. ISSN 0031-4005.
↑ Chiavaroli, Valentina; DAdamo, Ebe; Diesse, Laura; de, Tommaso; Chiarelli, Francesco; Moh, Angelika (2011). “Primary and Secondary Amenorrhea”. doi:10.5772/17675.
↑ Fritz, Marc (2011). Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0781779685.
↑ Klein DA, Poth MA (2013). “Amenorrhea: an approach to diagnosis and management”. Am Fam Physician. 87 (11): 781–8. PMID 23939500.
↑ Master-Hunter T, Heiman DL (2006). “Amenorrhea: evaluation and treatment”. Am Fam Physician. 73 (8): 1374–82. PMID 16669559.

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[Herman-GiddensSlora1997-1] Herman-Giddens, M. E.; Slora, E. J.; Wasserman, R. C.; Bourdony, C. J.; Bhapkar, M. V.; Koch, G. G.; Hasemeier, C. M. (1997). “Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network”. PEDIATRICS. 99 (4): 505–512. doi:10.1542/peds.99.4.505. ISSN 0031-4005.

[ChiavaroliDAdamo2011-2] Chiavaroli, Valentina; DAdamo, Ebe; Diesse, Laura; de, Tommaso; Chiarelli, Francesco; Moh, Angelika (2011). “Primary and Secondary Amenorrhea”. doi:10.5772/17675.

[3] Fritz, Marc (2011). Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0781779685.

[pmid23939500-4] Klein DA, Poth MA (2013). “Amenorrhea: an approach to diagnosis and management”. Am Fam Physician. 87 (11): 781–8. PMID 23939500.

[pmid16669559-5] Master-Hunter T, Heiman DL (2006). “Amenorrhea: evaluation and treatment”. Am Fam Physician. 73 (8): 1374–82. PMID 16669559.

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