Primary amenorrhea, which by definition is failure to reach menarche, is often the result of chromo somal irregularities leading to primary ovarian insufficiency e. The two main disease categories are crohns disease cd and ulcerative colitis uc, which have both overlapping and distinct clinical and pathological features. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. A 17yearold nulligravid female presented to the adolescent gynecology clinic for primary amenorrhea. Evaluation of primary amenorrhea differential diagnosis of. Secondary amenorrhea is the absence of menses for 3 months in a woman with previously normal menses or 9 months in a woman with oligomenorrhea light or. Primary amenorrhea is failure of menses to occur by age 15 years in patients with normal growth and secondary sexual characteristics. Background primary amenorrhea is defined as the absence of menses at age 15 years in the presence of normal growth and secondary sexual characteristics. Amenorrhea free download as powerpoint presentation. Complete absence of menstruation in a young woman who is at least 16 years old, or at age 14 with a lack of normal growth or absence of secondary sexual development. Primary amenorrhea signs and symptoms, causes, treatment. Amenorrhea absence of menses can be a transient, intermittent, or permanent condition resulting from dysfunction of the hypothalamus, pituitary, ovaries.
She underwent thelarche and pubarche at age 14, and was tanner iv breast and pubic hair development. Primary amenorrhea is also suspected when a female hasnt had menarche by age and doesnt show signs of puberty, which include developing secondary sexual characteristics like breasts. However, at age years, if no menses have occurred and there is a complete absence of secondary sexual characteristics such as breast development, evaluation for primary amenorrhea should. Evaluation of primary amenorrhea differential diagnosis. Links to pubmed are also available for selected references. Another definition of primary amenorrhea includes girls who have not menstruated within 5 years of breast development. The most common cause of primary amenorrhea is turner syndrome, where one x chromosome is either completely or partially absent. If arup consult does not answer your test selection and interpretation questions, or if youd like to suggest ways to improve content or usability, please leave a message for the arup clinical content team. Amenorrhea means you do not have menstrual periods. Inflammatory bowel disease ibd is a group of idiopathic chronic inflammatory intestinal conditions. The pathophysiology of amenorrhea in the adolescent.
In contrast, if menstruation has begun but has subsequently ceased for more than three cycles or 6 months, the term secondary amenorrhea is used. Breast development thelarche should occur by age otherwise, it requires evaluation. The identification of primary amenorrhea should always prompt a thorough evaluation to identify a cause 1. Fetal macrosomia diabetic o th er m anl bsiy pos td aeprg ncy 91. Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she. Primary amenorrhea is the lack of menstr uation by age 16 in the setting of normal development of secondary sexual. Current evaluation of amenorrhea the practice committee of the american society for reproductive medicine birmingham, alabama amenorrhea is the absence or abnormal cessation of the menses. If amenorrhea happens at other times, it may be the symptom of a treatable medical condition. Absence of menses for 6 months in a previously menstruating female.
Primary amenorrhea is the absence of the menstrual period by the age of 16. The cause can be either primary or secondary, while the function refers to the type of. Primary amenorrhea is defined as the absence of menses at age 15 years in the presence of normal growth and secondary sexual characteristics. Primary amenorrhea is the absence of menses by age 16 in the presence of otherwise normal secondary sexual characteristics or by age 14 if secondary sexual development has not occurred. Genetic or inborn conditions are the most common causes of primary amenorrhea. Primary amenorrhea is the absence of a first period in a young woman by the age of 16.
Secondary amenorrhea district i acog medical student education module 2011 definitions amenorrhea. Evaluation of amenorrhea, anovulation, and abnormal. Pdf disruptions in the menstrual cycle are a common complaint in primary care and womens health. If a teenaged girl doesnt get her period by the age of 16, she has primary amenorrhea or absence of menses, which is typically caused by structural or chromosomal abnormalities or functional problems with the hypothalamus or pituitary gland. Pa occurs in % of women in the reproductive age group. Amenorrhea is the medical term for the absence of menstrual periods, either over a permanent or temporary basis. Although overlapping attributes exist between the two groups, the diagnostic approaches vary significantly. It is a rare disorder as over 95% of girls have their first menstrual period by age 15. Even if you dont have periods, you could still get pregnant. The author has disclosed no potential conflicts of interest, financial or otherwise. Primary amenorrhea means you never start your periods.
Amenorrhea, the absence of menstrual bleeding, can be either primary or secondary. Doctors look for this if a girl does not start her period by age 15 or 3 years after she begins puberty. Primary amenorrhea is a delay in or a failure to start menstruation. Amenorrhea not due to pregnancy, lactation, or menopause is a relatively common abnormality of the reproductive years and indicative of a defect somewhere in the hypothalamicpituitaryovarianuterine axis.
A free powerpoint ppt presentation displayed as a flash slide show on id. Michael evans developed the onepager concept to provide clinicians with useful clinical information on primary care topics. Primary amenorrhea with transverse vaginal septum and scant. C, 6 women with polycystic ovary syndrome should be tested for glucose intolerance. However, at age years, if no menses have occurred and there is a complete absence of secondary sexual characteristics such as breast development. Get a printable copy pdf file of the complete article 619k, or click on a page image below to browse page by page. Secondary sexual characteristics and menses in young girls seen in office practice. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea. Menarche usually occurs at around 12 years of age, within three years of breast development when most girls have tanner breast stage iv. Full text full text is available as a scanned copy of the original print version. Primary amenorrhea article about primary amenorrhea by the.
Current evaluation of amenorrhea university of florida. Primary amenorrhea with transverse vaginal septum and. Primary amenorrhea due to hypothalamic disease cancer. It is caused by dysfunctioning of the pituitary gland, ovaries, uterus, and hypothalamus, by surgical removal of the ovaries or uterus, by medication, or by emotional trauma. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. Absence must be for 3 cycles according to certain sources 6 months according to most sources. Evaluation and management of a patient with amenorrhea is common in gynecology, and the prevalence of pathologic amenorrhea ranges from 3 to 4 percent in reproductiveaged populations bachmann, 1982. Evaluation should begin if no pubertal development has occurred by age, if menarche has not occurred by age 15, or if menarche has not occurred within five years of thelarche. It also considers the diagnosis and treatment of abnormal uterine bleeding at all stages of life. Join our community just now to flow with the file primary amenorrhoea and make our shared file collection even more complete and exciting.
Primary amenorrhea should be considered in any patient with secondary sex characteristics who has not experienced periodic menstruation by 15 years of age or 5 years after breast development. Primary amenorrhea is an absence of secondary sexual characters until 14 years of age or absence of menstruation with secondary sexual characters until 16 years of age. Amenorrhea is the transient or permanent absence of menstrual flow and may be subdivided into primary and secondary presentations, relative to menarche. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation breastfeeding, the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method. Amenorrhea is when a girl is not getting her period more to know. This onepage primer provides useful clinical information on a primary care topic. There are many causes of primary amenorrhea, and depending on the cause, it may affect clinical presentation e. Up to 50% of competitive runners training 80 miles per week and up to 44% of ballet dancers have amenorrhea. Primary amenorrhea is defined as a failure to reach menarche. The aim of this article is to study the frequency, etiologic causes, presentation, diagnosis, and optimal mode of management of. A female patient with primary amenorrhea and sexual development, including pubic hair, should be evaluated for the presence of a uterus and vagina. Primary continued uss absent uterus and normal fsh then mullerian agenesis or androgen insensitivity is likely if breasts, normal fsh and uterus then focus on causes of secondary amenorrhoea.
Nov 30, 2015 magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Primary amenorrhea an overview sciencedirect topics. Amenorrhea is the absence of a menstrual period in a woman of reproductive age. Pdf amenorrhea results when the orderly sloughing of the uterine lining on account of the interactions of hormones fails to occur. In contrast, prolonged amenorrhea might be the earliest sign of a decline in general health or signal an underlying condition. Amenorrhoea amenorrhoea is the absence of menses in a woman of reproductive age. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Various factors such as anatomical, genetic and hormonal factors reported to influence pa. Primary amenorrhea is defined as the absence of m en s by wh at g.
Case presentation and teaching on primary and secondary amenorrhea. At age years, if no menses have occurred and there is a complete absence of secondary sexual. Ppt amenorrhea powerpoint presentation free to view. What is the difference between primary and secondary. Primary amenorrhea pa is defined by the absence of attainment of menarche by the age of 1618 years. Amenorrhea primary and secondary abmormal uterine bleeding has multiple causes. The pathophysiology of amenorrhea in the adolescent neville h.
Primary amenorrhea is defined as the absence of menstruation by the age of 16 years in the presence of normal growth and secondary sexual characteristics. Secondary amenorrhea means you have had periods, and then they stop, especially for more than 3 months. Magnitude of the problem secondary amenorrhea prevalence about 3% primary amenorrhea prevalence about 0. Primary ovarian failure xchromosome abnormality turner syndrome fsh receptor deficiency autoimmune gonadal destruction functional hypothalamic amenorrhea eating disorder, exercise, weight loss stress, chronic illness delayed puberty 20% gonadotropin releasing hormone gnrh deficiency 20% consider mri. Carlson division of adolescent medicine, stanford university school of medicine, mountain view, california, usa menstrual irregularity is a common occurrence during adolescence, especially within the. Evaluation and management of primary amenorrhea uptodate. Primary amenorrhea definition of primary amenorrhea by. Amenorrhea is the term used when a woman or adolescent girl is not having menstrual periods. The majority of the causes of primary and secondary. Primary amenorrhea is defi ned as absence of menstruation by age 14 with absence of growth or development of secondary sexual characteristic or as absence of menstruation by 16 years regardless of presence of normal growth and development of secondary sexual characteristics 1. Amenorrhea facts amenorrhea refers to the absence of menstrual periods.
A proposal document of the japan society of obstetrics and gynecology committee for the redefinition of primary amenorrhea. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. It is important to consider all causes of secondary amenorrhea in the evaluation of primary amenorrhea. A comprehensive guide to hypothalamic amenorrhea recovery and much more, including fertility treatments, pregnancy and postpartum question, and life after recovery. However if patients have had no menstrual periods by age and have no signs of puberty eg, any type of breast development, they should be evaluated for primary amenorrhea. Treatment options differ for both primary and secondary amenorrhea. Feb 26, 2019 there are two main ways to classify amenorrhea, one is by the cause and the other is by the function. The identification of primary amenorrhea should always prompt a thorough evaluation to identify a cause. However, at age years, if no menses have occurred and there is a complete absence of secondary sexual characteristics such.
Secondary amenorrhoea is absence of periods for at least 3 months if the patient has previously had regular periods, and 6 months if she has previously had oligomenorrhoea. This chapter considers the various causes of amenorrhea and their treatment. Secondary and primary amenorrhea definition, causes, treatment. Amenorrhea including hypothalmic amenorrhea is a condition in which there is an absense of menstrual periods in a woman. Carlson division of adolescent medicine, stanford university school of medicine, mountain view, california, usa menstrual irregularity is a common occurrence during adolescence, especially within. Primary amenorrhea is defined as absence of menstruation by age 16 90. Primary amenorrhea is defined either as absence of menses by age 14 years with the absence of growth or development of secondary sexual characteristics eg. Primary amenorrhoea usually the result of a genetic or anatomical abnormality all causes of secondary amenorrhoea can present as primary nb sheehans causes of primary amenorrhoea cause % chromosomal gonadal dysgenesis 50 hypothalamic hypogonadism 20. Amenorrhea gynecology and obstetrics merck manuals. Renee andreeff is an academic coordinator and a clinical assistant professor in the pa program at dyouville college in buffalo, n. Primary amenorrhea is defined as failure to reach menarche.
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