Materiały źródłowe

• #1 Amenorrhea – StatPearls – NCBI Bookshelf

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

  The prognosis depends on the underlying etiology, and a complete discussion can be found within the articles on each etiology. Issues related to both general health and fertility should be considered. Generally, etiologies that can be surgically corrected (eg, imperforate hymen) or fully reversed (eg, FHA) have an excellent prognosis. […] Complications associated with specific underlying conditions (eg, chronic hypoestrogenic state, unopposed estrogen) can arise, including: Vasomotor symptoms, Osteoporotic fractures, Endometrial hyperplasia, Metabolic and cardiovascular disease, Infertility, Galactorrhea, Hyperandrogenism effects (eg, virilization, hirsutism, and acne), Psychological effects (eg, anxiety, depression).

• #2 Amenorrhea: Practice Essentials, Pathophysiology, Etiology

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

  Prognosis […] Loss of menstrual regularity has been associated with an increased risk of wrist and hip fractures related to reduced bone density, even without the development of amenorrhea. A later menarche and menstrual cycle intervals longer than 32 days have both been associated with increased fracture rates in later years. Young women with ovarian insufficiency that is unresponsive to therapy require hormone replacement to maintain bone density. […] Adolescence is a critical period for bone accretion as over half of peak bone mass is achieved during the teenage years. Regular menses is a sign that the ovaries are producing normal amounts of estrogen, androgens, and progesterone, all of which play an important role in building and maintaining bone mass. Late menarche has been associated with a 3-fold increase in the risk of wrist fracture.

• #3 Prognosis in primary amenorrhea – PubMed

  https://pubmed.ncbi.nlm.nih.gov/207584/

  A retrospective review of 62 patients with primary amenorrhea indicates that thoughtful clinical evaluation combined with dynamic hypothalamic-pituitary testing can usually determine the etiology and prognosis. […] Luteinizing hormone-releasing hormone (LH-RH) stimulation, sometimes combined with clomiphene therapy and estrogen provocation tests, assisted with prognostic and pathophysiologic evaluation, although patient management rarely changed. […] An age-inappropriate LH-RH test result was helpful in identifying patients with abnormal maturational patterns.

• #4 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. […] Amenorrhea can be associated with clinically challenging pathology and may require lifelong treatment. Patients will benefit from ample time with the clinician, sensitivity, and emotional support. […] Patients with primary ovarian insufficiency should be treated with hormone therapy until the age of natural menopause (50 to 51 years of age) to reduce the risk of osteoporosis, cardiovascular disease, and urogenital atrophy.

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

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

  In patients with functional hypothalamic amenorrhea, 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. […] In patients with polycystic ovary syndrome and an elevated body mass index, weight loss and regular exercise are recommended and may restore regular menses and improve metabolic comorbidities. […] Approximately 10% of females diagnosed with primary ovarian insufficiency retain fertility. […] A primary ovarian insufficiency diagnosis introduces long-term challenges for patients and families. Clinicians should offer ample time, sensitivity, and emotional support to the patient. […] 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. […] Patients with chronic disease may experience amenorrhea; however, these conditions are often recognized by individual signs and symptoms.

• #6 Amenorrhea: Practice Essentials, Pathophysiology, Etiology

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

  In some cases, loss of menstrual regularity is an early sign of declining fertility and impending premature ovarian failure. Also in some cases, follicle depletion progresses to cause irreversible infertility. Approximately 10% of women evaluated for amenorrhea in a tertiary center are found to have premature ovarian failure. […] Women with PCOS have many long-term health issues, including higher risk of diabetes and cardiovascular disease, that should be monitored and treated. […] The results of a study by Shufelt et al revealed endothelial dysfunction, a preclinical marker of cardiovascular disease, in 1 out of 3 young women with functional hypothalamic amenorrhea.

• #7 (PDF) Secondary Amenorrhea: Causes, Management And Outcome Using Algorithmic Approach

  https://www.academia.edu/36901298/Secondary_Amenorrhea_Causes_Management_And_Outcome_Using_Algorithmic_Approach

  Secondary amenorrhea in women of reproductive age may be an indication of an undiagnosed, chronic condition and appropriate treatment is dependent upon accurate diagnosis of the underlying etiology. […] The algorithmic approach to laboratory evaluation in the context of secondary amenorrhea described in this review can minimize the risk of diagnostic error as well was decrease test volume, cost, and time to diagnosis. […] The aim of the study is to evaluate the cause of secondary, management and outcome of secondary amenorrhea using an algorithmic approach in 100 cases patients of secondary amenorrhea who attended gynaecological OPD. […] 84 patient cases of secondary amenorrhea showed positive withdrawal response with Medroxy progesterone acetate (10 mg OD x 5 days) while rest 16 percent did not have any withdrawal bleeding with it. […] Many a times unnecessary costly investigations are carried out to know the cause of secondary amenorrhea.

• #8 Predictors of the resumption of menses in adolescent anorexia nervosa | BMC Psychiatry | Full Text

  https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-308

  The resumption of menses is an important indicator of recovery in anorexia nervosa (AN). […] However, the clinical variables that predict the recovery of menstrual function during weight gain in AN remain poorly understood. […] Forty-seven percent of the patients spontaneously began menstruating during the follow-up period. […] The absence of menarche before admission, a higher premorbid BMI, discharge below target weight, and a longer duration of hospital treatment were the most relevant prognostic factors for continued amenorrhea. […] The recovery of menstrual function in adolescent patients with AN should be a major treatment goal to prevent severe long-term physical and psychological sequelae. […] Patients with premenarchal onset of AN are at particular risk for protracted amenorrhea despite weight rehabilitation.

• #9 Predictors of the resumption of menses in adolescent anorexia nervosa | BMC Psychiatry | Full Text

  https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-308

  Reaching and maintaining a target weight between the 15th and 20th BMI percentile is favorable for the resumption of menses within 12 months. […] The absence of menarche at hospital admission strongly predicted persistent amenorrhea at the 12-month follow-up. […] The duration of hospital treatment also had predictive value. […] The achievement of target weight (defined as the 15-20th age-adjusted BMI percentile) before discharge from hospital treatment was a significant positive predictor of the resumption of menses at the 12-month follow-up. […] Thus, the determination of an adequate target weight is essential, as sufficient weight rehabilitation and stabilization are necessary for the resumption of menses. […] A target weight corresponding to a range between the 15th and 20th BMI percentile seems to be favorable in terms of the resumption of menses.

• #10 Recognizing menopause in women with amenorrhea induced by cytotoxic chemotherapy for endocrine-responsive early breast cancer in: Endocrine-Related Cancer Volume 19 Issue 2 (2012)

  https://erc.bioscientifica.com/view/journals/erc/19/2/R21.xml

  Cytotoxic anticancer treatment may induce amenorrhea or menopause to a variable extent. […] Women over 40 years of age with chemotherapy-induced amenorrhea (CIA) and routine hormonal levels consistent with menopause may receive an AI as adjuvant endocrine treatment. […] The risk of CT-POI has been correlated with the type of CT, higher cumulative doses and older age, age 40 years being the strongest predictor of both CIA and CIM. […] The occurrence of CIM is reported to be in the range of 2261% in women 40 years and 6197% in those 40 years. […] Rates of CIA in premenopausal women receiving a poly-CT regimen for EBC may range from 49 to 100% in women 40 years and from 21 to 71% in younger women. […] The likelihood of resuming ovarian function decreases as a woman approaches the mean age of natural menopause (51 years) and when more ovarian toxic agents are included in CT regimens.

• #11 Association of Personal Care and Consumer Product Chemicals with Long-Term Amenorrhea: Insights into Serum Globulin and STAT3

  https://www.mdpi.com/2305-6304/13/3/187

  Chemicals in personal care and consumer products are suspected to disrupt endocrine function and affect reproductive health. However, the link between mixed exposure and long-term amenorrhea is not well understood. […] Long-term amenorrhea, the absence of menstruation, is a common gynecological condition affecting approximately 3–5% of women annually. Long-term amenorrhea, particularly when it occurs without clear underlying causes such as pregnancy or menopause, is often indicative of underlying endocrine or metabolic imbalances. […] Emerging evidence suggests a potential link between PCCPs and the risk of long-term amenorrhea. […] The study of mixed chemical exposures and their impact on long-term amenorrhea is particularly important, given the multifactorial nature of the condition.

• #12 Association of Personal Care and Consumer Product Chemicals with Long-Term Amenorrhea: Insights into Serum Globulin and STAT3

  https://www.mdpi.com/2305-6304/13/3/187

  Long-term amenorrhea can be associated with altered globulin levels. […] This cross-sectional study aims to address these knowledge gaps by analyzing data from the National Health and Nutrition Examination Survey (NHANES) to explore the associations between individual and combined exposures to PFASs, PAEs, phenols, and parabens and the risk of long-term amenorrhea in a representative U.S. adult population. […] Logistic regression analysis identified significant associations between selected chemicals and long-term amenorrhea. […] Given the importance of serum globulin and its diverse roles in chronic inflammation, oxidative stress, and lipid metabolism, for the six PFASs significantly associated with long-term amenorrhea, serum globulin was studied as a mediator. […] This study identified significant associations between exposure to PFDA, PFHxS, PFNA, n_PFOA, n_PFOS, and Sm_PFOS and long-term amenorrhea, with PFHxS and n_PFOA being the primary contributors to mixed exposure. Mediation analyses confirmed that serum globulin partially mediates the association between exposure to PFHxS, PFNA, Sm_PFOS, and n_PFOA and the risk of long-term amenorrhea. […] These findings offer novel insights into the occurrence of long-term amenorrhea and support the potential of targeting PCCPs as preventive intervention measures.

• #13 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/

  Most of the causes of primary and secondary amenorrhea are similar. […] Most cases of amenorrhea are accounted for by six conditions: polycystic ovary syndrome, thyroid disorders, hyperprolactinemia, hypogonadotropic and hypergonadotropic hypogonadism, and anatomic abnormalities once congenital abnormalities are ruled out. […] History, physical examination, and estimation of serum FSH and estradiol will identify the most common causes of amenorrhea. […] Most patients presenting with amenorrhea should undergo measurements of serum prolactin and TSH, and pregnancy should be excluded. […] Physical examination and measurement of gonadotropins are key in the evaluation of primary amenorrhea. […] The diagnostic yield of physical examination alone may be less for cases of secondary in comparison to primary amenorrhea.

• #14 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. […] Typically, your period will return once you treat the underlying cause. However, it may take time to become regular again. […] In some cases, you may have a health problem that means you’ll never have a period. If that’s the case, your provider can talk to you about fertility options if you wish to become pregnant.

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