What are the causes of amenorrhea?

Causes of Amenorrhea: 

A. Ovarian causes/failure: 

  • Ovarian dysgenesis ( due to Turner's syndrome)
  • Premature ovarian failure 
  • Steroid biosynthesis defect 
  • Resistant ovary syndrome 
  • Oophorectomy, chemotherapy, radiotherapy 
  • PCOS 
  • Mumps oophoritis 
  • Drugs: Depot medroxyprogesterone acetate

B. Gonadotrophin failure (Hypothalamic-pituitary disease ):

  • Pituitary causes:
    • Kallmann syndrome/ nIHH ( normosmic idiopathic hypogonadotropic hypogonadism)
    • Sheehan syndrome 
    • Hyperprolactinaemia 
      • Prolactinoma 
      • Idiopathic hyperprolactinaemia 
      • Hypothyroidism 
      • Physiological in lactation 
      • Dopamine antagonist drugs
  • Possible hypothalamic causes-
    • Hypothalamic amenorrhea 
    • Weight-related amenorrhea 
    • Exercise-induced amenorrhea and anorexia 
    • Post-pill amenorrhea 
    • General or chronic illness ( e.g. chronic renal failure)
    • Excessive stress

C. Androgen excess: 

  • Gonadal or adrenal tumours (e.g. Arrhenoblastoma, Androgen-secreting adrenal tumour )
  • Congenital adrenal hyperplasia 

D. Uterine or vaginal cause/abnormalities:

  • Pregnancy 
  • Asherman's syndrome 
  • Absent uterus 
  • Imperforate hymen 
  • LNG-IUS ( levonorgestrel-releasing intrauterine system)

[This image is taken from Kumar & Clark’s Clinical Medicine 9e, Box: 26.32]

From Taber's Cyclopedic Medical Dictionary:

Arrhenoblastoma: An ovarian tumour that secretes male sex hormone, causing virilization in the female 
Asherman's syndrome: Presence of adhesions in the endometrial lining of the uterus, often causing secondary amenorrhea, infertility, or repeated spontaneous abortion.
Post-pill amenorrhea: Amenorrhea after stopping contraceptive therapy. 
Sheehan syndrome: Hypopituitarism due to an infarct of the pituitary after postpartum shock or hemorrhage. 
Kallmann syndrome: A disorder whose hallmarks are the congenital absence of the sense of smell and decreased the functional activity of the sex organs, resulting from insufficient production of gonadotropin-releasing hormone.
[Source: Kumar & Clark’s Clinical Medicine 9e and  Essentials of Obstetrics and Gynaecology, page: 27]

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