Materiały źródłowe

• #1 Amenorrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482168/

  Amenorrhea is a menstrual symptom characterized by the absence of menstruation in a female of reproductive age. […] Most of the underlying causes of amenorrhea can be classified into general groups: outflow tract abnormalities, ovarian failure or insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, and physiologic or medication induced. Proper management of amenorrhea requires an accurate diagnosis of the underlying etiology. […] The basic requirements for normal menstrual function include four anatomically and functionally distinct structural components: the hypothalamus, anterior pituitary gland, ovary, and the genital outflow tract composed of the uterus/endometrium, cervix, and vagina. If any of these components are nonfunctional or abnormal, menstrual bleeding cannot occur.

• #1 Amenorrhea – Harvard Health

  https://www.health.harvard.edu/womens-health/amenorrhea-a-to-z

  Amenorrhea is when a woman of childbearing age fails to menstruate. The part of the brain called the hypothalamus regulates the menstrual cycle. The hypothalamus stimulates the pituitary gland. The pituitary gland releases two hormones that regulate the female reproductive cycle. They are luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH influence the production of estrogen and progesterone. These hormones control cyclic changes in the lining of the uterus. This includes menstruation. In order for a woman to have regular menstrual cycles, her hypothalamus, pituitary gland, ovaries, and uterus must be functioning properly. Her cervix and vagina must also have a normal anatomy. […] Secondary amenorrhea can be caused by: pregnancy (the most common cause), breastfeeding, menopause, the normal age-related end of menstruation, emotional or physical stress, rapid weight loss, frequent strenuous exercise, hormonal birth control methods, including birth control pills, the patch, and long-acting progesterone, polycystic ovary syndrome, premature ovarian failure, hysterectomy, abnormal production of certain hormones, such as testosterone, thyroid, and cortisone, tumors of the pituitary gland, chemotherapy.

• #1 Amenorrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482168/

  Estrogen stimulates endometrial growth, while progesterone causes endometrial stabilization and maturation. […] Primary ovarian insufficiency (POI) is the reduction or dysfunction of ovarian follicles resulting in the cessation of menses in women aged 40 years or younger. […] Numerous additional hormonal abnormalities can also cause HPO axis dysfunction; these disorders are more commonly associated with secondary amenorrhea than primary amenorrhea. […] Regular menstruation depends on a complex sequence of events consisting of hormone production leading to ovulation, the effects of hormonal fluctuations from ovulation and the absence of fertilization on the endometrium, and an anatomically normal reproductive tract where this physiologic process can occur. […] The treatment for amenorrhea is based on correcting the underlying etiology and monitoring the patient for complications.

• #1 The Mechanism of Menstruation – Amenorrhea. A Case-Based, Clinical Guide

  https://doctorlib.org/gynecology/amenorrhea/2.html

  Withdrawal of progesterone at menstruation leads to increased MMP production and activation as well as release of TIMPs, thus causing matrix degradation. The degradation of tissue matrix results in massive tissue destruction, loss of structural integrity, and vascular disruption. […] An endometrium, receptive to embryo implantation, is prepared and shed each month during the menstrual cycle. A woman typically will have about 500 menstrual cycles in her lifetime. Disorders of the menstruation are a common problem and one of the most frequent indications for medical care in a reproductive-aged woman. Precisely regulated tissue degradation, controlled hemorrhage, and rapid hemostasis and repair are required for normal menstruation.

• #1 Amenorrhea: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/3924-amenorrhea

  Amenorrhea is often a sign of a treatable condition. With treatment, your regular menstrual cycle will usually resume. […] A complex system of hormones controls your menstrual cycle. Every cycle, these hormones prepare your uterus for a possible pregnancy. If there’s no pregnancy that cycle, you shed your uterine lining. That shedding is your period. […] Primary amenorrhea occurs when you haven’t had a period by 15 years old. Common causes include chromosomal or genetic problems that affect your reproductive system, such as Turner syndrome. Hormonal issues stemming from problems with your brain or pituitary gland. Structural problem with your organs, such as missing parts of your uterus or vagina or having an underdeveloped reproductive system. […] Secondary amenorrhea is when you miss your period for three or more months after previously having a normal period. Common causes include some birth control methods, such as Depo-Provera, intrauterine devices (IUDs) and certain birth control pills. Chemotherapy and radiation therapy for cancer. Previous uterine surgery with scarring. Stress. Poor nutrition. Weight changes extreme weight loss or gain. Extreme exercise routines. Certain medications.

• #1 Amenorrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482168/

  Determining the underlying cause of amenorrhea will assist in guiding management decisions. […] The reproductive cycle is controlled by the HPO axis, which directs the pulsatile release of gonadotropin-releasing hormone (GnRH), and, therefore, disorders affecting the function of the hypothalamus or pituitary gland can disrupt menstruation. […] The most common etiology of amenorrhea in adolescent girls is functional hypothalamic amenorrhea (FHA). […] FHA is a pathologic condition caused by a relative energy deficiency leading the hypothalamus to suppress the body’s reproductive cycle. […] Prolactinomas are prolactin-secreting tumors of the anterior pituitary gland. […] Other rare hypothalamic and pituitary causes of amenorrhea include inherited deficiencies of GnRH-producing neurons, known as Kallman syndrome when amenorrhea is present with anosmia, pituitary infarction (eg, Sheehan syndrome), infiltrative disease (eg, cancer, sarcoidosis, hemochromatosis), craniopharyngioma, autoimmune disease, and empty sella syndrome due to traumatic or iatrogenic causes.

• #1 Functional hypothalamic amenorrhea: Pathophysiology and clinical manifestations – UpToDate

  https://www.uptodate.com/contents/functional-hypothalamic-amenorrhea-pathophysiology-and-clinical-manifestations

  Functional hypothalamic amenorrhea (FHA) is the term used to describe amenorrhea that results from such causes and is diagnosed after ruling out other etiologies of amenorrhea. […] Low energy availability (from decreased caloric intake, excessive energy expenditure, or both) and stress are common causes of hypogonadotropic hypogonadism in women. […] Risk factors for FHA include low-weight eating disorders (in particular anorexia nervosa [AN]) and other causes of low weight, excessive exercise, and stress. […] FHA is responsible for approximately 25 to 35 percent and 3 percent of secondary and primary amenorrhea cases, respectively. […] Many women of reproductive age engage in some form of exercise. Most obtain health benefits from such activity, but some develop menstrual dysfunction, particularly when caloric intake cannot keep pace with exercise energy expenditure. […] In addition, excessive exercise and/or inadequate caloric intake leading to relative energy deficiency at a critical time in development may delay menarche.

• #1 Exercise amenorrhoea – Wikipedia

  https://en.wikipedia.org/wiki/Exercise_amenorrhoea

  Exercise amenorrhoea is a medical condition in which women involved in heavy exercise experience absence of menstruation of varying periods of time. It occurs because of neuroendocrine dysfunction and is usually reversible. […] There occurs a suppression in the generation of gonadotropin releasing hormone (GnRH). The secretion of GnRH normally occurs in a pulsatile fashion, every 60 to 90 minutes. This is absent in exercise amenorrhoea. The function of GnRH is to stimulate the secretion of leutinizing hormone (LH) and follicle stimulating hormone (FSH). As a result, LH and to a certain extent FSH are secreted in low quantities. These hormones are necessary for normal menstruation, and result in amenorrhoea if not secreted in adequate quantities. […] Exercise amenorrhoea can be managed by eating a diet rich in calories and by decreasing the duration and intensity of exercise for at least 12 months. Amenorrhea usually persists and may take over 6 months to reverse.

• #1 The effects of weight loss-related amenorrhea on women’s health and the therapeutic approaches: a narrative review

  https://atm.amegroups.org/article/view/108383/html

  Weight loss-related amenorrhea is defined as the reversible functional inhibition of the hypothalamic-pituitary-ovarian (HPO) axis associated with weight loss or low body weight, which occurs mostly in adolescents and women of reproductive age. […] The specific mechanism that how adipose and adipokines effect reproduction indirectly or directly has not yet been fully elucidated. An energy deficient state, hypoestrogenism, and other abnormal endocrinological and metabolic activities not only impair female reproductive function, but also affect critical physiological functions of other tissues and organs. […] The mechanisms underlying the pathophysiology of FHA are elusive. In addition to leptin, kisspeptin, NPY, ghrelin, CRH, -endorphin, and allopregnanolone have complex interactions and act together to affect reproduction.

• #1 Amenorrhea pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Amenorrhea_pathophysiology

  Leptin plays an important role in energy consumption, body composition, food intake along with sexual maturation and reproductive improvement. […] It is assumed that leptin plays a role in the development of hypothalamic amenorrhea. […] Antipsychotic drugs and other medications that have an inhibitory effect on dopamine D2 receptor lead to an increased level of prolactin. Higher levels of prolactin suppress pulsatile GnRH secretion and block positive feedback of estradiol on hypothalamus, leading to disruption of HPO axis. […] Kallmann syndrome, a genetic disorder caused by KAL gene mutation, has disturbance in migration of olfactory nerves along with GnRH neurons. Lack of GnRH leads to absence of secondary sexual characteristics and amenorrhea. […] Prolactinoma is one of the most common anterior pituitary tumors. Prolactinoma leads to increased prolactin secretion and along with the tumor’s mass effect may cause suppression of GnRH.

• #1 Amenorrhea: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/3924-amenorrhea

  The following medical conditions may also cause secondary amenorrhea: Primary ovarian insufficiency (POI), when your ovaries stop working before age 40. Hypothalamic amenorrhea, a condition where amenorrhea occurs due to an issue with your hypothalamus. Pituitary disorders, such as a benign pituitary tumor or excessive production of prolactin. Hormonal imbalances as a result of conditions like polycystic ovary syndrome, adrenal disorders or hypothyroidism. Ovarian tumors. Obesity. Ongoing illness or chronic illness (like kidney disease or inflammatory bowel disease). […] Amenorrhea isn’t life-threatening. However, some causes can lead to long-term complications, so amenorrhea should always be evaluated by a healthcare provider. Having amenorrhea may make you more likely to develop osteoporosis or cardiovascular disease (due to a lack of estrogen). Difficulties getting pregnant or infertility. Pelvic pain (if structural issues are the cause).

• #1 Amenorrhea: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0601/p781.html

  Primary ovarian insufficiency, a condition characterized by follicle depletion or dysfunction leading to a continuum of impaired ovarian function, is suggested by a concentration of follicle-stimulating hormone in the menopausal range (per reference laboratory), confirmed on two occasions separated by one month, and diagnosed in patients younger than 40 years with amenorrhea or oligomenorrhea. […] More than 90% of cases unrelated to a syndrome are idiopathic, but they can be attributed to radiation, chemotherapeutic agents, infection, tumor, empty sella syndrome, or an autoimmune or infiltrative process. […] Functional hypothalamic amenorrhea occurs when the hypothalamic-pituitary-ovarian axis is suppressed due to an energy deficit stemming from stress, weight loss (independent of original weight), excessive exercise, or disordered eating.

• #1 Amenorrhea – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/amenorrhea/

  Ovulatory dysfunction includes abnormalities ranging from occasional menstrual cycle irregularities to chronic anovulation. […] Ovarian insufficiency is the failure of adequate ovarian function (endocrine as well as reproductive) before the age of 40, which often leads to premature menopause. […] Pathophysiology: follicular dysfunction or depletion estrogen levels reduced feedback inhibition of estrogen on FSH and LH FSH and LH (usually FSH LH). […] Functional hypothalamic amenorrhea is defined as anovulation due to dysfunctional GnRH secretion. […] Decreased leptin (low body fat) and/or increased cortisol (exercise/stress) decreased pulsatile release of GnRH from the hypothalamus decreased secretion of FSH and LH decreased estrogen levels anovulation and secondary amenorrhea infertility.

• #1 Amenorrhea – Wikipedia

  https://en.wikipedia.org/wiki/Amenorrhea

  Any pathology in the hypothalamus or pituitary can alter the way this feedback mechanism works and can cause secondary amenorrhea. […] Prolactin secreting pituitary adenomas cause amenorrhea due to the hyper-secretion of prolactin which inhibits FSH and LH release. […] Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 48% of women worldwide. […] It is characterized by multiple cysts on the ovary, amenorrhea or oligomenorrhea, and increased androgens. […] Although the exact cause remains unknown, it is hypothesized that increased levels of circulating androgens is what results in secondary amenorrhea. […] Energy imbalance and weight loss can disrupt menstrual cycles through several hormonal mechanisms. […] Weight loss can cause elevations in the hormone ghrelin which inhibits the hypothalamic-pituitary-ovarial axis.

• #1 Amenorrhea pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Amenorrhea_pathophysiology

  In hypothyroidism, the main mechanism that can lead to amenorrhea is the influence of thyrotropin releasing hormone (TRH) on lactotroph cells, increasing prolactin levels. […] Congenital adrenal hyperplasia (CAH) is a group of genetic enzyme deficiencies in adrenal gland. […] In polycystic ovary syndrome (PCOS) insulin resistance leads to increased androgen production. […] Primary ovarian insufficiency is multifactorial and leads to ovarian failure and decrease in estrogen which leads to amenorrhea. […] The main pathogenesis of amenorrhea in androgen insensitivity syndrome is the absence of uterus. […] One of the acquired conditions that can lead to amenorrhea is Asherman syndrome. […] Mayer-Rokitansky-Kuster-Hauser syndrome is complete agenesis of uterine, blind ended vagina. […] Imperforated hymen, transverse vaginal septum, and vaginal agenesis are other anatomical disorders of female reproductive system that can lead to amenorrhea.

• #1 Amenorrhea – Wikipedia

  https://en.wikipedia.org/wiki/Amenorrhea

  Amenorrhea is a symptom with many potential causes. […] Although amenorrhea has multiple potential causes, ultimately, it is the result of hormonal imbalance or an anatomical abnormality. […] Physiologically, menstruation is controlled by the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus. […] GnRH acts on the pituitary to stimulate the release of follicle stimulating hormone (FSH) and luteinizing hormone (LH). […] Amenorrhea can be caused by any mechanism that disrupts this hypothalamic-pituitary-ovarian axis, whether that it be by hormonal imbalance or by disruption of feedback mechanisms. […] Disturbances in thyroid hormone regulation has been a known cause of menstrual irregularities, including secondary amenorrhea. […] Changes in the hypothalamic-pituitary axis is a common cause of secondary amenorrhea.

• #1 Amenorrhea > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/amenorrhea

  The thyroid gland produces hormones that control metabolism and affect puberty and menstruation. A gland that is overactive (hyperthyroidism) or underactive (hypothyroidism) can cause amenorrhea. […] Tumors on this gland are not usually cancerous, but they can interfere with menstruation. […] Treatment for amenorrhea typically focuses on addressing the underlying disorder that is causing it, through the use of behavioral modification, medications, surgeries, or a combination of both.

• #1 Amenorrhoea & Oligomenorrhoea – Causes – Investigations – TeachMeObGyn

  https://teachmeobgyn.com/gynaecology/menstrual/oligomenorrhoea/

  To achieve regular menstrual cycles, all components of the hypothalamic-pituitary-ovarian axis needs to be functioning appropriately. […] Disease of the hypothalamus can reduce the secretion of GnRH. This, in turn, decreases the pulsatile release of LH and FSH from the anterior pituitary gland causing anovulation. […] The anterior pituitary gland releases LH and FSH, which are necessary for menses to occur. Common causes of pituitary amenorrhoea include: Prolactinomas represent 40-50% of all pituitary tumours. They secrete high levels of prolactin, which suppresses GnRH secretion. This causes anovulation, amenorrhoea and galactorrhoea. […] Disease of the adrenal gland can affect ovulation. Late onset/mild congenital adrenal hyperplasia is an autosomal recessive inherited condition which is caused by partial deficiency of 21 hydroxylase (an enzyme required for synthesis of cortisol and aldosterone). […] Any obstruction to the normal menses flow causes concealed bleeding and pain.

• #1 Amenorrhea – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/amenorrhea

  Amenorrhea can occur when ovulation is normal, as occurs when genital anatomic abnormalities (eg, congenital anomalies causing outflow obstruction, intrauterine adhesions [Asherman syndrome]) prevent normal menstrual flow despite normal hormonal stimulation. […] When part of this system malfunctions, ovulatory dysfunction occurs; the cycle of gonadotropin-stimulated estrogen production and cyclic endometrial changes is disrupted, resulting in anovulation, and menstrual flow may not occur. Ovulatory dysfunction is the most common cause of amenorrhea, particularly secondary amenorrhea. […] Amenorrhea due to ovulatory dysfunction is usually secondary but may be primary if ovulation never begins, because of a genetic disorder. If ovulation never begins, delayed puberty usually results, and development of secondary sexual characteristics is abnormal.

• #1 Amenorrhea | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17439

  Amenorrhea can be caused by obstruction of the cervix due to scarring after a cervical procedure, radiation, neoplasia, or atrophy. […] Regular menstruation depends on a complex sequence of events consisting of hormone production leading to ovulation, the effects of hormonal fluctuations from ovulation and the absence of fertilization on the endometrium, and an anatomically normal reproductive tract where this physiologic process can occur. […] If any of these components are nonfunctional or abnormal, menstrual bleeding may not occur; however, the precise pathophysiology associated with amenorrhea may vary based on the underlying etiology and sometimes may be unclear.

• #1 Contribution of chromosomal aberrations to the pathogenesis of primary and secondary amenorrhea: A study from Western Iran

  https://www.ecerm.org/journal/view.php?doi=10.5653/cerm.2024.06807

  Amenorrhea is an abnormal condition characterized by the absence of menstruation in women of reproductive age. […] Several studies have named chromosomal abnormalities among the main causes of amenorrhea, though the prevalence of these abnormalities may differ across populations. […] From a genetic perspective, amenorrhea can be attributed to single-gene and chromosomal defects. […] Chromosomal abnormalities are another common cause of amenorrhea. […] Various studies have estimated that chromosomal abnormalities occur in 10% to 25% of PA cases. […] Early referral for cytogenetic testing is strongly recommended to identify underlying chromosomal abnormalities in patients with amenorrhea. […] Given the key role of chromosomal abnormalities in the development of amenorrhea and the subsequent counseling and management of patients, accurately determining the frequency of these abnormalities is paramount.

• #1 Amenorrhea pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Amenorrhea_pathophysiology

  Amenorrhea is defined as absence of menstrual cycle. The causes of amenorrhea include hypothalamic, pituitary, thyroid, adrenal, ovarian, uterine, and vaginal. About 25 different genes are involved in the pathogenesis of amenorrhea including 3 different groups of Kallmann syndrome related genes, hypothalamus-pituitary-gonadal (HPG) axis related genes, and obesity related genes. […] The pathophysiology of amenorrhea is multifactorial and include hypothalamic, pituitary, thyroid, adrenal, ovarian, uterine, and vaginal causes. […] The most common cause of amenorrhea in adolescents are hypothalamic disorders and is known as hypothalamic amenorrhea. […] The most common cause of amenorrhea after 2-3 years of onset of puberty include eating disorders, excessive exercise, medications, and psychosocial stress.

• #1 Amenorrhea: A Systematic Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0701/p39.html

  Patients diagnosed with primary ovarian insufficiency should be offered testing for FMR1 gene premutation, which confers the risk of fragile X syndrome in children. […] Hormone replacement therapy (HRT) may reduce associated vasomotor symptoms, bone mineral density loss, and cardiovascular risk and should be continued until the age of natural menopause (50 to 51 years).

• #1 The effects of weight loss-related amenorrhea on women’s health and the therapeutic approaches: a narrative review

  https://atm.amegroups.org/article/view/108383/html

  Weight loss-related amenorrhea is an underestimated clinical problem not only in terms of its morbidity but also in terms of its effects on fertility. […] Estrogens are the critical determinants that ensure normal bone metabolism in women. […] Long periods of hypoestrogenism can lead to CVD, which is common in postmenopausal women. […] Hypoestrogenism in young women with FHA is strongly related to the activity changes of various neuropeptides, neurotransmitters, and neurosteroids in the brain. […] Weight loss-related amenorrhea is a condition that involves the reversible inhibition of the normal function and activity of the HPO axis. […] The treatment of chronic menstrual disorders, anovulation, secondary amenorrhea, and infertility resulting from hypothalamic disorders should first aim to alleviate the primary causes. […] Pulsatile GnRH therapy is an efficient and practical treatment for ovulation induction in FHA patients. […] Leptin is an important mediator that affects reproduction in acute or chronic energy deficient patients by regulating the HPO axis, ovarian function, and the activin-follistatin system.

• #1 Amenorrhea: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/3924-amenorrhea

  If your period stopped because of menopause, lactation or pregnancy, your provider won’t need to treat it. In other cases, your treatment will depend on the cause and may include following a diet and exercise plan that help you maintain a weight that’s healthy for you. Stress management techniques. Changing exercise levels. Hormonal treatment (medication), as prescribed by your healthcare provider. Surgery (in rare cases). […] Most cases of amenorrhea are treatable. With treatment, your periods should start to happen regularly. It can take a few months for your periods to come back, but in most cases, they will. Talk to your healthcare provider about what you can expect with treatment.

• #2 Amenorrhea: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/252928-overview

  Amenorrhea is the absence of menstrual bleeding. […] In the absence of pregnancy, the challenge is to determine the exact cause of absent menses. […] The menstrual cycle can be divided into 3 physiologic phases: follicular, ovulatory, and luteal. Each phase has a distinct hormonal secretory milieu. Consideration of the target organs of these reproductive hormones (hypothalamus, pituitary, ovary, uterus) is helpful for identifying the disease process responsible for a patients amenorrhea. […] Hypothalamic dysfunction results in decreased or inhibited GnRH secretion, which affects the pulsatile release of pituitary gonadotropins, LH and FSH, causing anovulation. A common cause of amenorrhea is functional hypothalamic amenorrhea. […] It is characterized by abnormal hypothalamic GnRH secretion, decreased gonadotropin pulsations, low or normal LH concentrations, absent LH surges, abnormal follicular development, and low serum estradiol.

• #2 Amenorrhea | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17439

  Amenorrhea is a menstrual symptom characterized by the absence of menstruation in a female of reproductive age. […] There are numerous potential etiologies of amenorrhea. Most of the underlying causes of amenorrhea can be classified into general groups: outflow tract abnormalities, ovarian failure or insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, and physiologic or medication-induced. […] The basic requirements for normal menstrual function include four anatomically and functionally distinct structural components: the hypothalamus, anterior pituitary gland, ovary, and the genital outflow tract composed of the uterus/endometrium, cervix, and vagina. If any of these components are nonfunctional or abnormal, menstrual bleeding cannot occur. […] Determining the underlying cause of amenorrhea will assist in guiding management decisions.

• #2 Amenorrhea: A Systematic Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0701/p39.html

  Menstrual patterns can be an indicator of overall health and self-perception of well-being. Primary amenorrhea, defined as the lifelong absence of menses, requires evaluation if menarche has not occurred by 15 years of age or three years post-thelarche. Secondary amenorrhea is characterized by cessation of previously regular menses for three months or previously irregular menses for six months and warrants evaluation. […] Clinicians may consider etiologies of amenorrhea categorically as outflow tract abnormalities, primary ovarian insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, sequelae of chronic disease, physiologic, or induced. […] Patients with primary ovarian insufficiency can maintain unpredictable ovary function and may require hormone replacement therapy, contraception, or infertility services. Functional hypothalamic amenorrhea may indicate disordered eating and low bone density. Treatment should address the underlying cause.

• #2 Amenorrhea – Harvard Health

  https://www.health.harvard.edu/womens-health/amenorrhea-a-to-z

  Amenorrhea is when a woman of childbearing age fails to menstruate. The part of the brain called the hypothalamus regulates the menstrual cycle. The hypothalamus stimulates the pituitary gland. The pituitary gland releases two hormones that regulate the female reproductive cycle. They are luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH influence the production of estrogen and progesterone. These hormones control cyclic changes in the lining of the uterus. This includes menstruation. In order for a woman to have regular menstrual cycles, her hypothalamus, pituitary gland, ovaries, and uterus must be functioning properly. Her cervix and vagina must also have a normal anatomy. […] Secondary amenorrhea can be caused by: pregnancy (the most common cause), breastfeeding, menopause, the normal age-related end of menstruation, emotional or physical stress, rapid weight loss, frequent strenuous exercise, hormonal birth control methods, including birth control pills, the patch, and long-acting progesterone, polycystic ovary syndrome, premature ovarian failure, hysterectomy, abnormal production of certain hormones, such as testosterone, thyroid, and cortisone, tumors of the pituitary gland, chemotherapy.

• #2 Amenorrhea: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/252928-overview

  Evidence suggests a negative correlation between body fat levels and menstrual abnormalities. A critical body fat level must be present for the reproductive system to function normally. […] Menarche and sustained menstrual cycles requires normal function of the endocrine axis comprising the hypothalamus, pituitary, and ovaries. Any disruption in this axis may result in amenorrhea. Defining the level of primary dysfunction is critical in determining the pathophysiology of amenorrhea.

• #2 Secondary Amenorrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431055/

  Functional hypothalamic amenorrhea and prolactinomas are the most commonly encountered etiologies of secondary amenorrhea. […] In addition to direct abnormalities in the hypothalamus or pituitary gland, numerous other hormonal abnormalities may interact with and affect HPO axis function and result in abnormal menstruation or secondary amenorrhea. […] Primary ovarian insufficiency (POI) refers to the depletion or dysfunction of ovarian follicles that leads to the cessation of menses before 40. […] The major acquired causes of uterine and outflow tract abnormalities include iatrogenic endometrial suppression, intrauterine adhesions (Asherman syndrome), and cervical stenosis. […] The prognosis of secondary amenorrhea depends on the underlying etiology. […] Prolonged hypoestrogenic states can result in BMD loss and osteoporotic fractures, as well as sexual dysfunction due to vaginal dryness. Conversely, prolonged exposure to unopposed estrogen during anovulatory cycles can lead to endometrial hyperplasia and malignancy.

• #2 Amenorrhea: A Systematic Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0701/p39.html

  Amenorrhea can be associated with clinically challenging pathology and may require lifelong treatment. […] Etiologies of amenorrhea can be categorized as: outflow tract abnormalities, primary ovarian insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, sequelae of chronic disease, physiologic, or induced. […] Functional hypothalamic amenorrhea is a disorder of chronic anovulation caused by suppression of the hypothalamic-pituitary axis from body weight loss, excessive exercise, or stress and may result in infertility or bone density loss. […] The pathology is similar to the female athlete triad; both are characterized by menstrual dysfunction, low energy availability, and decreased bone mineral density. […] Treatment should correct the underlying cause to restore ovulatory function through behavior change, nutritional repletion (e.g., caloric intake, vitamin D), stress reduction, and weight gain.

• #2 Amenorrhea: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0601/p781.html

  Primary ovarian insufficiency, a condition characterized by follicle depletion or dysfunction leading to a continuum of impaired ovarian function, is suggested by a concentration of follicle-stimulating hormone in the menopausal range (per reference laboratory), confirmed on two occasions separated by one month, and diagnosed in patients younger than 40 years with amenorrhea or oligomenorrhea. […] More than 90% of cases unrelated to a syndrome are idiopathic, but they can be attributed to radiation, chemotherapeutic agents, infection, tumor, empty sella syndrome, or an autoimmune or infiltrative process. […] Functional hypothalamic amenorrhea occurs when the hypothalamic-pituitary-ovarian axis is suppressed due to an energy deficit stemming from stress, weight loss (independent of original weight), excessive exercise, or disordered eating.

• #2 Hypothalamic Amenorrhea: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24431-hypothalamic-amenorrhea

  Often, its a combination of all of these factors that lead to FHA (like exercising too much and not eating enough calories). This puts your hypothalamus in survival mode, putting certain bodily processes and functions on hold so it can focus on the most important ones (like breathing). […] When it comes to your menstrual cycle, GnRH is responsible for triggering your body to create FSH and LH. These two hormones cause your ovary to release an egg (ovulation) during each menstrual cycle. Without sufficient levels of FSH and LH, ovulation and menstruation stop. […] Hypothalamic amenorrhea can lead to low estrogen levels. Estrogen is an important hormone in your body. One function of estrogen is to maintain healthy, strong bones. Without estrogen, females are at risk for osteoporosis and heart disease. Estrogen also helps with your mood. Lack of estrogen may lead to symptoms of depression and anxiety.

• #2 Amenorrhea – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/amenorrhea/

  Ovulatory dysfunction includes abnormalities ranging from occasional menstrual cycle irregularities to chronic anovulation. […] Ovarian insufficiency is the failure of adequate ovarian function (endocrine as well as reproductive) before the age of 40, which often leads to premature menopause. […] Pathophysiology: follicular dysfunction or depletion estrogen levels reduced feedback inhibition of estrogen on FSH and LH FSH and LH (usually FSH LH). […] Functional hypothalamic amenorrhea is defined as anovulation due to dysfunctional GnRH secretion. […] Decreased leptin (low body fat) and/or increased cortisol (exercise/stress) decreased pulsatile release of GnRH from the hypothalamus decreased secretion of FSH and LH decreased estrogen levels anovulation and secondary amenorrhea infertility.

• #2 Amenorrhea | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17439

  Prolactinomas are prolactin-secreting tumors of the anterior pituitary gland. […] They create a state of hyperprolactinemia, which suppresses the HPO axis. […] Estrogen stimulates endometrial growth, while progesterone causes endometrial stabilization and maturation. […] When these sex hormones are not present in significant quantities due to gonadal dysfunction, menstruation does not occur. […] Primary ovarian insufficiency (POI) is the reduction or dysfunction of ovarian follicles resulting in the cessation of menses in women aged 40 years or younger. […] Numerous additional hormonal abnormalities can also cause HPO axis dysfunction; these disorders are more commonly associated with secondary amenorrhea than primary amenorrhea. […] Elevated serum androgens suppress the HPO axis, and the most common cause of amenorrhea in the setting of hyperandrogenemia is polycystic ovary syndrome (PCOS).

• #2 Current evaluation of amenorrhea: a committee opinion (2024) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/current-evaluation-of-amenorrhea/

  In women with hyperprolactinemia, the prevalence of a pituitary tumor is 50%60% (8). […] Most patients presenting with amenorrhea should undergo measurements of serum prolactin and TSH, and pregnancy should be excluded. […] The presence of breast development indicates previous estrogen action. When breast development is absent, this finding is typically indicative of hypogonadism, including hypogonadotropic causes (congenital gonadotropin-releasing hormone [GnRH] deficiency, central nervous system lesions, functional hypothalamic amenorrhea [FHA]) and hypergonadotropic causes (gonadal dysgenesis and primary ovarian insufficiency [POI]). […] Lack of gonadal function is marked by high FSH levels. Gonadal failure can occur at any age, even in utero, when it is usually the result of gonadal agenesis or dysgenesis.

• #2 Secondary Amenorrhea – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431055/

  Secondary amenorrhea occurs due to abnormalities at various points in the „menstrual pathway,” including the hypothalamus, pituitary, ovaries, endometrium, cervix, and vagina. […] Common nonphysiologic causes include functional hypothalamic amenorrhea (FHA), polycystic ovary syndrome (PCOS), hyperprolactinemia, primary ovarian insufficiency (POI), and intrauterine adhesions. […] The underlying etiologies of secondary amenorrhea vary widely, involving physiologic, hypothalamic, pituitary, ovarian, endometrial, and cervical etiologies, as well as other endocrine and hormonal causes that can also affect the HPO axis. […] Abnormalities in the hypothalamus or pituitary gland disrupt the HPO axis and thus can suppress menses. […] Numerous potential causes of hypothalamic and pituitary dysfunction can result in secondary amenorrhea, including functional hypothalamic amenorrhea, prolactinomas, infarction/necrosis (Sheehan syndrome), infectious causes, infiltrative disease, inherited etiologies (Kallman syndrome), and empty sella syndrome.

• #2 Contribution of chromosomal aberrations to the pathogenesis of primary and secondary amenorrhea: A study from Western Iran

  https://www.ecerm.org/journal/view.php?doi=10.5653/cerm.2024.06807

  In the present study, we aimed to gather detailed information on the frequency of chromosomal abnormalities in PA and SA through a comprehensive analysis of a relatively large population in Kermanshah Province, Western Iran. […] While the etiology of amenorrhea is highly heterogeneous, genetic factors, including chromosomal and single-gene abnormalities, account for approximately 40% of cases. […] The overall rate of chromosomal abnormalities in SA is approximately 7%, with the majority of these cases being mosaic in nature. […] The observed phenotypic variation may stem in part from different distributions of the 45,X and i(X) cell lines across various tissues, since only peripheral blood is analyzed during routine karyotyping. […] These findings could pave the way for improved disease management and genetic counseling for patients with amenorrhea.

• #2 Amenorrhea: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/3924-amenorrhea

  The following medical conditions may also cause secondary amenorrhea: Primary ovarian insufficiency (POI), when your ovaries stop working before age 40. Hypothalamic amenorrhea, a condition where amenorrhea occurs due to an issue with your hypothalamus. Pituitary disorders, such as a benign pituitary tumor or excessive production of prolactin. Hormonal imbalances as a result of conditions like polycystic ovary syndrome, adrenal disorders or hypothyroidism. Ovarian tumors. Obesity. Ongoing illness or chronic illness (like kidney disease or inflammatory bowel disease). […] Amenorrhea isn’t life-threatening. However, some causes can lead to long-term complications, so amenorrhea should always be evaluated by a healthcare provider. Having amenorrhea may make you more likely to develop osteoporosis or cardiovascular disease (due to a lack of estrogen). Difficulties getting pregnant or infertility. Pelvic pain (if structural issues are the cause).

• #2 Amenorrhea | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/17439

  Amenorrhea can be caused by obstruction of the cervix due to scarring after a cervical procedure, radiation, neoplasia, or atrophy. […] Regular menstruation depends on a complex sequence of events consisting of hormone production leading to ovulation, the effects of hormonal fluctuations from ovulation and the absence of fertilization on the endometrium, and an anatomically normal reproductive tract where this physiologic process can occur. […] If any of these components are nonfunctional or abnormal, menstrual bleeding may not occur; however, the precise pathophysiology associated with amenorrhea may vary based on the underlying etiology and sometimes may be unclear.

• #2 Amenorrhea pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Amenorrhea_pathophysiology

  Amenorrhea is defined as absence of menstrual cycle. The causes of amenorrhea include hypothalamic, pituitary, thyroid, adrenal, ovarian, uterine, and vaginal. About 25 different genes are involved in the pathogenesis of amenorrhea including 3 different groups of Kallmann syndrome related genes, hypothalamus-pituitary-gonadal (HPG) axis related genes, and obesity related genes. […] The pathophysiology of amenorrhea is multifactorial and include hypothalamic, pituitary, thyroid, adrenal, ovarian, uterine, and vaginal causes. […] The most common cause of amenorrhea in adolescents are hypothalamic disorders and is known as hypothalamic amenorrhea. […] The most common cause of amenorrhea after 2-3 years of onset of puberty include eating disorders, excessive exercise, medications, and psychosocial stress.

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