[1an- + meno- + -rrhea]
Absence of menstruation or menarche. Amenorrhea may be either primary (a failure to begin menstruating by age 16), or secondary (an absence of menstruation for more than 3 months in women who used to menstruate and who are not pregnant). Amenorrhea may be classed as physiological when it occurs during pregnancy, during early lactation, or after menopause or is caused by medications, e.g., by some forms of hormonal contraception. Pathological, secondary, amenorrhea is caused by several conditions.
The primary causes of secondary amenorrhea are related either to an underlying hypothalamic-pituitary-endocrine dysfunction or to congenital or acquired abnormalities of the reproductive tract. Common abnormal diagnoses include metabolic disorders, e.g., diabetes, polycystic ovarian syndrome (PCOS), malnutrition, or obesity; emotional and stress-related disorders, e.g., anorexia nervosa; and systemic diseases, e.g., cancer, lupus, or tuberculosis.
The underlying cause should be determined and corrected. If hormone deficiencies exist, substitutional therapy is recommended. Reproductive age and need for contraception must also be considered for treatment.
The patient is assessed for other symptoms and is encouraged to seek medical attention if absence of menses is not related to pregnancy, menopause, or hormonal therapy.
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