Amenorrhea-An abnormal cessation of normal menstrual cycle
Main Article Content
Abstract
Amenorrhea is the absence or abnormal cessation of menstrual cycles in a woman of reproductive age. Prolonged cessation of menstrual cycles might results in complications such as infertility, psychosocial developmental delays, Osteoporosis, fractures etc. Better understanding of physiology of menstruation is essential to understand the various causes of primary and secondary amenorrhea. Any disruption or functional abnormality in the hypothalamic-pituitary-ovarian axis can result in abnormal menstruation or amenorrhea. Therefore it is crucial to identify this menstrual distress in women at early age to minimize the risks of reproductive dysfunction in premenstrual and postmenstrual conditions.
Article Details
Copyright (c) 2020 Khan NT, et al.

This work is licensed under a Creative Commons Attribution 4.0 International License.
Treloar AE, Boynton RE, Behn BG, Brown BW. Variation of the human menstrual cycle through reproductive life. Int J Fertil. 1967; 12: 77-126. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/5419031
Vollman RF. The menstrual cycle. Major Probl Obstet Gynecol. 1977; 7: 1-193. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/836520
Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Family Physician. 2006; 73: 1374-1382.
Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril. 2004; 82: 33-39. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19007635
Heiman DL. Amenorrhea. Prim Care. 2009; 36: 1-17. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19231599
Grinspoon S, Miller K, Coyle C, Krempin J, Armstrong C, et al. Severity of osteopenia in estrogen-deficient women with anorexia nervosa and hypothalamic amenorrhea. J Clin Endocrinol Metab. 1999; 84: 2049-2055. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10372709
Gordon CM. Functional hypothalamic amenorrhea. New England Journal of Medicine. 2010; 363: 365-371.
Golden NH, Carlson JL. The pathophysiology of amenorrhea in the adolescent. Ann N Y Acad Sci. 2008; 1135: 163-178. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18574222
Rothman MS, Wierman ME. Female hypogonadism: evaluation of the hypothalamic–pituitary–ovarian axis. Pituitary. 2008; 11: 163-169. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18404388
Rebar RW. Hypergonadotropic amenorrhea and premature ovarian failure: a review. J Reprod Med. 1982; 27: 179-186. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6808131
Benson JE, Engelbert-Fenton KA, Eisenman PA. Nutritional aspects of amenorrhea in the female athlete triad. Int J Sport Nutr. 1996; 6: 134-145. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8744786
McIver B, Romanski SA, Nippoldt TB. Evaluation and management of amenorrhea. Mayo Clin Proc. 1997; 72: 1161-1169. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9413300
Hirschberg AL, Hagenfeldt K. Athletic amenorrhea and its consequences. Hard physical training at an early age can cause serious bone damage. Lakartidningen. 1998; 95: 5765-5770. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9889498
Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014; 37: 1049-1056. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25201001
Rebar RW, Connolly HV. Clinical features of young women with hypergonadotropic amenorrhea. Fertil Steril. 1990; 53: 804-810. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2110072
Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Fam Physician. 2006; 73: 1374-1382. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16669559
Timmreck LS, Reindollar RH. Contemporary issues in primary amenorrhea. Obstet Gynecol Clin North Am. 2003; 30: 287-302. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12836721
Chae HD, Kang EH, Chu HS, Kim JH, Kang BM, et al. Clinical characteristics of amenorrhea according to the etiological classification. Korean J Obstet Gynecol. 1999; 42: 975-980.
Child T. Investigation and treatment of primary amenorrhoea. Obstetrics, Gynaecology & Reproductive Medicine. 2011; 21: 31-35.
Lardenoije C, Aardenburg R, Mertens H. Imperforate hymen: a cause of abdominal pain in female adolescents. BMJ Case Rep. 2009; bcr0820080722. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21686660
Liu JH, Patel B, Collins G. Central causes of amenorrhea. In Endotext [Internet]. 2016. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25905176
Pletcher JR, Slap GB. Menstrual disorders: amenorrhea. Pediatr Clin North Am. 1999; 46: 505-518. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10384804
Pettersson F, Fries H, Nillius SJ. Epidemiology of secondary amenorrhea: I. Incidence and prevalence rates. Am J Obstet Gynecol. 1973; 117: 80-86. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/4722382
Drew FL. The epidemiology of secondary amenorrhea. J Chronic Dis. 1961; 14: 396-407. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/13887810
Koninckx PR, Brosens IA. The “gonadotropin-resistant ovary” syndrome as a cause of secondary amenorrhea and infertility. Fertil Steril. 1977; 28: 926-931. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/892043
McGee C. Secondary amenorrhea leading to osteoporosis: incidence and prevention. Nurse Pract. 1997; 22: 38-41. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9172234
Howie PW. Breastfeeding: a natural method for child spacing. Am J Obstet Gynecol. 1991; 165: 1990-1991. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1755455
Tanmahasamut P, Rattanachaiyanont M, Dangrat C, Indhavivadhana S, Angsuwattana S, et al. Causes of primary amenorrhea: a report of 295 cases in Thailand. J Obstet Gynaecol Res. 2012; 38: 297-301. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22070792
Warren MP, Fried JL. Hypothalamic amenorrhea: the effects of environmental stresses on the reproductive system: a central effect of the central nervous system. Endocrinol Metab Clin North Am. 2001; 30: 611-629. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11571933
Benson JE, Engelbert-Fenton KA, Eisenman PA. Nutritional aspects of amenorrhea in the female athlete triad. Int J Sport Nutr. 1996; 6: 134-145. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8744786
Hally SS. Nutrition in reproductive health. J Nurse Midwifery. 1998; 43: 459-470. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9871379
Schwartz B, Cumming DC, Riordan E, Selye M, Yen SS, et al. Exercise-associated amenorrhea: a distinct entity?. Am J Obstet Gynecol. 1981; 141: 662-670. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7315895
De Souza MJ, Williams NI. Beyond hypoestrogenism in amenorrheic athletes: energy deficiency as a contributing factor for bone loss. Curr Sports Med Rep. 2005; 4: 38-44. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15659278
Rashid BM, Mahmoud TJ, Nore BF. Hormonal study of primary infertile women. J Zankoy Sulaimani-Part A. 2013; 15: 2.
MacGregor TN. Amenorrhoea: Aetiology and Treatment. Br Med J. 1938; 1: 717.-722. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20781357
Yen SS. Female hypogonadotropic hypogonadism: hypothalamic amenorrhea syndrome. Endocrinol Metab Clin North Am. 1993; 22: 29-58. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8449187
Caronia LM, Martin C, Welt CK, Sykiotis GP, Quinton R, et al. A genetic basis for functional hypothalamic amenorrhea. N Engl J Med. 2011; 364: 215-225. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21247312
Seminara SB, Crowley Jr WF. Perspective: the importance of genetic defects in humans in elucidating the complexities of the hypothalamic-pituitary-gonadal axis. Endocrinology. 2001; 142: 2173-2177. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11356659
Wilson GR, Haddad JE, Haddad CJ. Amenorrhea common causes and evaluation. Compr Ther. 2005; 31: 270-278. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16407607
Reindollar RH, Novak M, Tho SP, McDonough PG. Adult-onset amenorrhea: a study of 262 patients. Am J Obstet Gynecol. 1986; 155: 531-541. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3529965
Bachmann GA, Kemmann E. Prevalence of oligomenorrhea and amenorrhea in a college population. Am J Obstet Gynecol. 1982; 144: 98-102. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7114117
Harlow SD, Campbell OM. Epidemiology of menstrual disorders in developing countries: a systematic review. BJOG. 2004; 111: 6-16. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14687045
Fries H, Nillius SJ, Pettersson F. Epidemiology of secondary amenorrhea: II. A retrospective evaluation of etiology with special regard to psychogenic factors and weight loss. Am J Obstet Gynecol. 1974; 118: 473-479. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/4812568
Zondek B. Simplified hormonal treatment of amenorrhea. J Am Med Assoc. 1942; 118: 705-707. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12259270
Warren MP, Hagey AR. The genetics, diagnosis and treatment of amenorrhea. Minerva Ginecol. 2004; 56: 437-455. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15531861
Golden NH, Lanzkowsky L, Schebendach J, Palestro CJ, Jacobson MS, et al. The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa. J Pediatr Adolesc Gynecol. 2002; 15: 135-143. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12106749
Chen YT, Tenforde AS, Fredericson M. Update on stress fractures in female athletes: epidemiology, treatment, and prevention. Curr Rev Musculoskelet Med. 2013; 6: 173-181. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23536179
Dueck CA, Matt KS, Manore MM, Skinner JS. Treatment of athletic amenorrhea with a diet and training intervention program. Int J Sport Nutr. 1996; 6: 24-40. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8653102
Bennell K, Brukner P. Preventing and managing stress fractures in athletes. Physical Therapy in Sport. 2005; 6: 171-180.