II. Types

  1. Primary Amenorrhea
    1. No secondary sexual characteristics by 13 years old or
    2. No menstrual period by (failure to reach Menarche by):
      1. Fifteen years old or
      2. Five years after initial Breast development or
      3. One year beyond Family History
  2. Secondary Amenorrhea
    1. Previously regular cycles: 3 months of no Menses
    2. Previously irregular cycles: 6 months of no Menses

III. Causes: Axis 1 - Hypothalamus

  1. Primary Amenorrhea (congenital causes)
    1. Anovulation (10% of primary causes)
    2. Constitutional (6% of primary causes): Family History
    3. Gonadotropin deficiency such as Kallmann's Syndrome (Rare): Associated with Anosmia
  2. Secondary Amenorrhea (acquired causes)
    1. Anovulation (50% of secondary causes)
    2. Post-Hor monal Contraception (Post-Pill)
    3. CNS injury
      1. Traumatic Brain Injury
      2. Meningitis
      3. CNS Neoplasm
    4. Miscellaneous
      1. Eating Disorder (e.g. Anorexia Nervosa)
      2. Malabsorption, malnutrition or rapid weight loss

IV. Causes: Axis 2 - Pituitary

  1. Primary Amenorrhea (congenital causes)
    1. Hyperprolactinemia (2% of primary causes)
    2. Pituitary Tumor (8% of primary causes)
      1. Pituitary Adenoma (hormone producing)
      2. Pituitary Null Cell Tumor (No hormone produced)
      3. Empty Sella Syndrome
      4. Pituitary Tuberculosis
      5. Pituitary Schistosomiasis
  2. Secondary Amenorrhea (acquired causes)
    1. Hyperprolactinemia (25% of secondary causes)
      1. See Medication Causes of Hyperprolactinemia
    2. Sheehan Syndrome (rare)
    3. Hypothyroidism (1% of secondary causes): Prolactin-like effect
    4. Pituitary infiltration (e.g. Sarcoidosis)
    5. Cushing Syndrome

V. Causes: Axis 3 - Ovarian insufficiency

  1. Primary Amenorrhea (congenital causes)
    1. Polycystic Ovary Syndrome (10% of primary causes)
      1. Findings: Obesity, Hirsutism, and Acne Vulgaris
    2. Turners Syndrome and Mosaics (30% of primary causes)
      1. Findings: Short Stature, Web neck, and Shield Chest
    3. Genetic Male (10% of primary causes)
    4. Gonadal dysgenesis
  2. Secondary Amenorrhea (acquired causes)
    1. Polycystic Ovary Syndrome (8% of secondary causes)
    2. Premature Ovarian Failure (10% of secondary causes)
    3. Oophoritis (rare)
      1. Chemotherapy or Radiation
      2. Infection (e.g. Mumps, Tuberculosis)

VI. Causes: Axis 4: Uterus (outflow tract)

  1. Primary Amenorrhea (congenital causes)
    1. Mullerian Agenesis (20% of primary causes)
      1. Mayer-Rokitansky-Kuster-Hauser Syndrome
    2. Imperforate Hymen
    3. Transverse vaginal septum
    4. Complete androgen resistance
  2. Secondary Amenorrhea (acquired causes)
    1. Asherman Syndrome (5% of secondary causes)
    2. Endometritis
    3. Cervical stenosis

VII. Causes: Miscellaneous

  1. Other endocrine causes
    1. See Hypoandrogenism
    2. Adrenal hyperplasia (adult onset)
    3. Androgen-secreting tumor
    4. Cushing syndrome
    5. Polycystic Ovary Syndrome
    6. Hypothyroidism
  2. Physiologic causes
    1. Pregnancy!
    2. Lactation
    3. Contraception
    4. Menopause
    5. Exogenous androgens

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Ontology: Amenorrhea (C0002453)

Definition (CSP) absence of menses for three months or more.
Definition (MSH) Absence of menstruation.
Definition (PSY) Absence or abnormal cessation of the menses.
Concepts Disease or Syndrome (T047)
MSH D000568
ICD9 626.0
ICD10 N91.2
SnomedCT 156034000, 198414005, 156037007, 14302001
French AMENORRHEE, Absence de règles, Absence de menstruation, Aménorrhée SAI, Aménorrhée
English AMENORRHEA, AMENORRHOEA, Amenorrhoea NOS, Amenorrhea, unspecified, Amenorrhoea, unspecified, Amenorrhea NOS, amenia, amenorrhea, amenorrhea (diagnosis), Amenorrhea, Menses lack of, Amenorrhea [Disease/Finding], cessation of menses, menstruation absence, absence of menstruation, lack of menses, Amenorrhoea (finding), Amenorrhea NOS (finding), Amenorrhoea NOS (finding), Absence of menstruation, Amenorrhoea, Amenorrhea (finding), absence; menstruation, Absence of menstruation, NOS, Amenorrhea, NOS, Amenorrhoea, NOS, amenorrhoea
Portuguese AMENORREIA, Falta de menstruação, Amenorreia NE, Ausência de menstruação, Amenorreia
Spanish AMENORREA, Amenorrea NEOM, Ausencia de menstruación, Falta del periodo, Amenorrhoea NOS, amenorrea, SAI, amenorrea, SAI (hallazgo), Amenorrhea NOS, amenorrea (hallazgo), amenorrea, ausencia de menstruación, falta de menstruación, Amenorrea
German AMENORRHOE, Ausbleiben der Menstruation, Amenorrhoe NNB, Ausbleiben der Menses, Amenorrhoe, nicht naeher bezeichnet, Amenorrhoe
Dutch missende menstruatie, amenorroe NAO, afwezigheid van menstruatie, afwezigheid; menstruatie, Niet gespecificeerde amenorroe, amenorroe, Amenorroe
Italian Assenza di mestruazioni, Amenorrea NAS, Amenorrea
Japanese 無月経NOS, 月経欠如, ムゲッケイ, ゲッケイケツジョ, ムゲッケイNOS, 無月経
Swedish Menstruation, utebliven
Czech amenorea, Chybění menses, Amenorrhoea NOS, Amenorea, Nepřítomnost menstruace
Finnish Amenorrea
Russian AMENOREIA, АМЕНОРЕЯ
Korean 상세불명의 무월경
Croatian AMENOREJA
Polish Brak miesiączki
Hungarian Amenorrhoea k.m.n., Amenorrhoea, amenorrhoea, Menstruatio hiánya, Menses hiánya
Norwegian Manglende menstruasjon, Amenorrhea, Uteblitt menstruasjon, Amenoré