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Diseases » Amenorrhea » Causes
 

Causes of Amenorrhea

Contents
  1. Amenorrhea: Introduction
  2. List of Causes
  3. Drugs/substances (12 causes)
  4. Hidden causes
  5. Excerpts from book chapters
  6. Complication causes
  7. Causes of symptoms
  8. News
  9. Related cause information

List of causes of Amenorrhea

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Amenorrhea) that could possibly cause Amenorrhea includes:

More causes: see full list of causes for Amenorrhea

Causes of Amenorrhea (Diseases Database):

The follow list shows some of the possible medical causes of Amenorrhea that are listed by the Diseases Database:

Source: Diseases Database

Amenorrhea Causes: Book Excerpts

Amenorrhea as a complication of other conditions:

Other conditions that might have Amenorrhea as a complication may, potentially, be an underlying cause of Amenorrhea. Our database lists the following as having Amenorrhea as a complication of that condition:

Amenorrhea as a symptom:

Conditions listing Amenorrhea as a symptom may also be potential underlying causes of Amenorrhea. Our database lists the following as having Amenorrhea as a symptom of that condition:

Medications or substances causing Amenorrhea:

The following drugs, medications, substances or toxins are some of the possible causes of Amenorrhea as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

See full list of 12 medications causing Amenorrhea


Medical news summaries relating to Amenorrhea:

The following medical news items are relevant to causes of Amenorrhea:

Related information on causes of Amenorrhea:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Amenorrhea may be found in:

Causes of Amenorrhea: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Amenorrhea.

Amenorrhea: Differential Diagnosis
(In a Page: Signs and Symptoms)

Secondary amenorrhea

  • More common than primary
  • Hypothyroidism
  • Pregnancy
    • Polycystic ovarian syndrome
      –Peripubertal onset of menstrual irregularities with hyperandrogenism (hirsutism) and obesity
    • Functional hypothalamic amenorrhea due to stress, eating disorders, weight loss, or excessive exercise
    • Hyperprolactinemia
      –Galactorrhea
      –Secondary to medications (e.g., OCP, phenothiazines) or primary due to pituitary adenoma
      Primary amenorrhea
      • Constitutional delay of puberty
        –Family history of late puberty
        –Normal development at later age
        • Outflow tract disorders
          –Transverse vaginal septum
          –Imperforate hymen
          –Pelvic or lower abdominal pain are common presenting symptoms
        • Complete androgen insensitivity syndrome
          –X-linked recessive disorder (46,XY)
          –Resistance to testosterone due to a defect in the androgen receptor
          –Testes may be palpable in labia or inguinal area
      • Müllerian agenesis (Mayer-Rokitansky-Hauser syndrome)
        –Agenesis of fallopian tubes, uterus, vagina
        –Normally functioning ovaries
        Less common etiologies
        • Turner's syndrome
          –45,X gonadal dysgenesis
          –Ovaries replaced with fibrous tissue
        • Ovarian failure (autoimmune oophoritis or secondary to chemotherapy or radiation injury)
        • 5-αreductase deficiency
        • 17-αhydroxylase deficiency
        • Craniopharyngioma
        • Hypopituitarism
        • Congenital GnRH deficiency (Kallman's syndrome if associated with anosmia)
        • Cushing's syndrome

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Amenorrhea – Secondary: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Pregnancy
    –Most common cause
  • Anovulatory cycles
    –Common during first few years after menarche
    • Hyperandrogenism
      –Polycystic ovary syndrome: Problems with fertility are common, LH/FSH ratio is greater than 2.5/1
      –Some adrenal tumors
      –Congenital adrenal hyperplasia
      –Exposure to anabolic steroids
    • Major illness or stress
    • Large changes in weight
      –Anorexia nervosa
    • Hypothyroidism
    • Prolactinoma
    • Other causes of hyperprolactinemia
      –Marijuana
      –Opioids
      –Antidepressants
      –Phenothiazines
    • Hypothalamic-pituitary failure
      –Pituitary tumor
      –Sheehan syndrome
      –Cranial irradiation
    • Ovarian failure
      –Autoimmune destruction
      –Infarction due to gonadal torsion
      –Chemotherapy or radiation
      –Idiopathic
    • Oral contraceptives
      –May delay return to regular menses
    • Cushing syndrome
    • Uterine synechiae (Asherman syndrome)
    • Chiari-Frommel syndrome

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Amenorrhea – Primary: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Constitutional delay of puberty
    –Most common cause
    • Anatomic causes
      –Uterine aplasia (Mayer-Rokitansky syndrome)
      –Vaginal aplasia
      –Imperforate hymen
  • Hypogonadotropic hypogonadism
    –Decreased FSH
    –Congenital and acquired etiologies
  • Congenital hypogonadotropic hypogonadism
    –Kallmann syndrome
    –Panhypopituitarism
    • Aquired hypogonadotropic hypogonadism
      –Malnutrition
      –Stress
      –Anorexia nervosa
      –Inflammatory bowel disease
      –Celiac disease
      –Excessive exercise
      –Pituitary tumor (e.g., prolactinoma or craniopharyngioma)
  • Hypergonadotropic hypogonadism
    –Increased FSH
    –Gonadal dysgenesis (Turner syndrome is the most common)
    –Ovarian failure: Autoimmune oophoritis, galactosemia, effects of chemotherapy or radiation, FSH or LH receptor mutations (rare)
    • Abnormal thyroid function
    • Androgen insensitivity syndrome
    • Congenital adrenal hyperplasia and other causes of hyperandrogenism
    • Medications
    • Pregnancy

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Oligomenorrhea: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Adrenal hyperplasia

In adrenal hyperplasia, oligomenorrhea may occur with signs of androgen excess, such as clitoral enlargement and male distribution of hair, fat, and muscle mass.

Anorexia nervosa

Anorexia nervosa may cause sporadic oligomenorrhea or amenorrhea. Its cardinal symptom, however, is a morbid fear of being fat associated with weight loss of more than 20% of ideal body weight. Typically, the patient displays dramatic skeletal muscle atrophy and loss of fatty tissue; dry or sparse scalp hair; lanugo on the face and body; and blotchy or sallow, dry skin. Other symptoms include constipation, a decreased libido, and sleep disturbances.

Diabetes mellitus

Oligomenorrhea may be an early sign in diabetes mellitus. In insulin-dependent diabetes, the patient may have never had normal menses. Associated findings include excessive hunger, polydipsia, polyuria, weakness, fatigue, dry mucous membranes, poor skin turgor, irritability and emotional lability, and weight loss.

Hypothyroidism

Besides oligomenorrhea, hypothyroidism may result in fatigue; forgetfulness; cold intolerance; unexplained weight gain; constipation; bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails.

Prolactin-secreting pituitary tumor

Oligomenorrhea or amenorrhea may be the first sign of a prolactin-secreting pituitary tumor. Accompanying findings include unilateral or bilateral galactorrhea, infertility, loss of libido, and sparse pubic hair. A headache and visual field disturbances — such as diminished peripheral vision, blurred vision, diplopia, and hemianopia — signal tumor expansion.

Thyrotoxicosis

Thyrotoxicosis may produce oligomenorrhea along with reduced fertility. Cardinal findings include irritability, weight loss despite increased appetite, dyspnea, tachycardia, palpitations, diarrhea, tremors, diaphoresis, heat intolerance, an enlarged thyroid and, possibly, exophthalmos.

Other causes

Drugs

Drugs that increase androgen levels — such as corticosteroids, corticotropin, anabolic steroids, danocrine, and injectable and implanted hormonal contraceptives — may cause oligomenorrhea. Hormonal contraceptives may be associated with delayed resumption of normal menses when their use is discontinued; however, 95% of women resume normal menses within 3 months. Other drugs that may cause oligomenorrhea include phenothiazine derivatives and amphetamines, and antihypertensive drugs, which increase prolactin levels.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Amenorrhea: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Adrenal tumor. Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with the rapid onset of virilizing signs is usually indicative of an adrenal tumor.

❑ Adrenocortical hyperplasia. Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.

❑ Adrenocortical hypofunction. In addition to amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.

❑ Amenorrhea-lactation disorders. Amenorrhea-lactation disorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.

❑ Anorexia nervosa. Anorexia nervosa is a psychological disorder that can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, a blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.

❑ Congenital absence of the ovaries. Congenital absence of the ovaries results in primary amenorrhea and the absence of secondary sex characteristics.

❑ Congenital absence of the uterus. Primary amenorrhea occurs with congenital absence of the uterus. The patient may develop breasts.

❑ Corpus luteum cysts. Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.

❑ Hypothalamic tumor. In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.

❑ Hypothyroidism. Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.

❑ Mosaicism. Mosaicism results in primary amenorrhea and the absence of secondary sex characteristics.

❑ Ovarian insensitivity to gonadotropins. A hormonal disturbance, ovarian insensitivity to gonadotropins leads to amenorrhea and an absence of secondary sex characteristics.

❑ Pituitary tumor. Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache; visual disturbances, such as bitemporal hemianopsia; and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.

❑ Polycystic ovary syndrome. Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Or, periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.

❑ Pseudoamenorrhea. An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.

❑ Pseudocyesis. With pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.

❑ Testicular feminization. Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.

❑ Thyrotoxicosis. Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.

❑ Turner’s syndrome. Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.

❑ Uterine hypoplasia. Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.

Other causes

❑ Drugs. Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.

❑ Radiation therapy. Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.

❑ Surgery. Surgical removal of both ovaries or the uterus produces amenorrhea.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Amenorrhea: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Amenorrhea is normal before puberty, after menopause, or during pregnancy and lactation; it’s pathologic at any other time. It usually results from anovulation due to hormonal abnormalities, such as decreased secretion of estrogen, gonadotropins, luteinizing hormone, and follicle-stimulating hormone; lack of ovarian response to gonadotropins; or constant presence of progesterone or other endocrine abnormalities.

Amenorrhea may also result from the absence of a uterus, endometrial damage, or from ovarian, adrenal, or pituitary tumors. It’s also linked to emotional disorders and is common in patients with severe disorders, such as depression and anorexia nervosa. Mild emotional disturbances tend merely to distort the ovulatory cycle, while severe psychic trauma may abruptly change the bleeding pattern or may completely suppress one or more full ovulatory cycles. Amenorrhea may also result from malnutrition, intense exercise, and prolonged hormonal contraceptive use. The incidence of primary amenorrhea in the United States is less than 1%. The incidence of secondary amenorrhea (due to some other cause than pregnancy) is about 4%.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Oligomenorrhea: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Adrenal hyperplasia

In this disorder, oligomenorrhea may occur with signs of androgen excess, such as clitoral enlargement and male distribution of hair, fat, and muscle mass.

Anorexia nervosa

Anorexia nervosa may cause sporadic oligomenorrhea or amenorrhea. Its cardinal symptom, however, is a morbid fear of being fat associated with weight loss of more than 20% of ideal body weight. Typically, the patient displays dramatic skeletal muscle atrophy and loss of fatty tissue; dry or sparse scalp hair; lanugo on the face and body; and blotchy or sallow, dry skin. Other symptoms include constipation, decreased libido, and sleep disturbances.

Diabetes mellitus

Oligomenorrhea may be an early sign in this disorder. In juvenile-onset diabetes, the patient may have never had normal menses. Associated findings include excessive hunger, polydipsia, polyuria, weakness, fatigue, dry mucous membranes, poor skin turgor, irritability and emotional lability, and weight loss.

Hypothyroidism

Besides oligomenorrhea, this disorder may result in fatigue; forgetfulness; cold intolerance; unexplained weight gain; constipation; bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails.

Polycystic ovary disease

About 25% of women with polycystic ovary disease have oligomenorrhea; but some may have amenorrhea, menometrorrhagia, or irregular menses. Infertility, anovulation, and enlarged, palpable ovaries are also common. Other features vary but may include signs of androgen excess—male distribution of body hair and muscle mass, facial hair growth, acne and, occasionally, obesity.

Prolactin-secreting pituitary tumor

Oligomenorrhea or amenorrhea may be the first sign of a prolactin-secreting pituitary tumor. Accompanying findings include unilateral or bilateral galactorrhea, infertility, loss of libido, and sparse pubic hair. Headache and visual field disturbances—such as diminished peripheral vision, blurred vision, diplopia, and hemianopsia—signal tumor expansion.

Sheehan’s syndrome

This pituitary necrosis usually follows severe obstetric hemorrhage. Oligomenorrhea or amenorrhea may occur with failure to lactate, sparse pubic and axillary hair, decreased libido, and fatigue.

Thyrotoxicosis

This disorder may produce oligomenorrhea along with reduced fertility. Cardinal findings include irritability, weight loss despite increased appetite, dyspnea, tachycardia, palpitations, diarrhea, tremors, diaphoresis, heat intolerance, an enlarged thyroid and, possibly, exophthalmos.

Other causes

Drugs

Drugs that increase androgen levels—such as corticosteroids, corticotropin, anabolic steroids, danocrine, and injectable and implanted contraceptives—may cause oligomenorrhea. Hormonal contraceptives may be associated with delayed resumption of normal menses when their use is discontinued; however, 95% of women resume normal menses within 3 months. Other drugs that may cause oligomenorrhea include phenothiazine derivatives and amphetamines, and antihypertensive drugs, which increase prolactin levels.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Amenorrhea: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Adrenal tumor

Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with rapid onset of virilizing signs is usually indicative.

Adrenocortical hyperplasia

Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism also typically appear.

Adrenocortical hypofunction

Besides amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.

Amenorrhea-lactation disorders

Amenorrhea-lactation disorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.

Anorexia nervosa

Anorexia nervosa is a psychological disorder that can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.

Congenital absence of the ovaries

Congenital absence of the ovaries results in primary amenorrhea and absence of secondary sex characteristics.

Congenital absence of the uterus

Primary amenorrhea occurs with congenital absence of the uterus. The patient also may fail to develop breasts.

Corpus luteum cysts

Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.

Hypothalamic tumor

In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.

Hypothyroidism

Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.

Mosaicism

Mosaicism is a genetic disorder that results in primary amenorrhea and absence of secondary sex characteristics.

Ovarian insensitivity to gonadotropins

Ovarian insensitivity to gonadotropins is a hormonal disturbance that leads to amenorrhea and absence of secondary sex characteristics.

Pituitary infarction

Pituitary infarction usually causes postpartum failure to lactate and to resume menses. Although associated signs and symptoms depend on the infarction’s severity, they include headaches, visual field defects, oculomotor palsies, and an altered level of consciousness. The patient may also lose pubic and axillary hair.

Pituitary tumor

Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache, visual disturbances such as bitemporal hemianopia, and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.

Polycystic ovary syndrome

Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Alternatively, periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany polycystic ovary syndrome.

Pseudoamenorrhea

An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.

Pseudocyesis

In pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.

Sertoli-Leydig cell tumor

Sertoli-Leydig cell tumor is an ovarian tumor that may produce amenorrhea along with acne, hirsutism, deepening of the voice, balding, muscle mass development, and clitoral enlargement.

Testicular feminization

Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, exhibits breasts and external genitalia but scant or absent pubic hair.

Thyrotoxicosis

Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.

Turner’s syndrome

Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.

Uterine hypoplasia

Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.

Other causes

Drugs

Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.

Radiation therapy

Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.

Surgery

Surgical removal of both ovaries or the uterus produces amenorrhea.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Secondary Amenorrhea: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Pregnancy

❑ Menopause

❑ Functional hypothalamic amenorrhea

❑ Drugs

❑ Anorexia nervosa

❑ Post-contraceptive

❑ Endometrial scarring

❑ Endocrinopathy

❑ Hyperprolactinemia

❑ Premature ovarian failure

❑ Polycystic ovary syndrome

❑ Chromophobe adenoma

❑ Ovarian tumors

❑ Panhypopituitarism

❑ Müllerian dysgenesis

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Oligomenorrhea: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Adrenal hyperplasia

In adrenal hyperplasia, oligomenorrhea may occur with signs of androgen excess, such as clitoral enlargement, deepening voice, acne, and male distribution of hair, fat, and muscle mass.

Anorexia nervosa

Anorexia nervosa may cause sporadic oligomenorrhea or amenorrhea. Its cardinal symptom, however, is a morbid fear of being fat associated with weight loss of more than 20% of ideal body weight. Typically, the patient displays dramatic skeletal muscle atrophy and loss of fatty tissue; dry or sparse scalp hair; lanugo on the face and body; and blotchy or sallow, dry skin. Other symptoms include constipation, decreased libido, and sleep disturbances.

Diabetes mellitus

Oligomenorrhea may be an early sign of diabetes mellitus. In juvenile-onset diabetes, the patient may have never had normal menses. Associated findings include excessive hunger, polydipsia, polyuria, weakness, fatigue, dry mucous membranes, poor skin turgor, irritability and emotional lability, and weight loss.

Hypothyroidism

Besides oligomenorrhea, hypothyroidism may result in fatigue; forgetfulness; cold intolerance; unexplained weight gain; constipation; bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails.

Polycystic ovary disease

About 25% of women with polycystic ovary disease have oligomenorrhea, but some may have amenorrhea, menometrorrhagia, or irregular menses. Infertility, anovulation, and enlarged, palpable ovaries are also common. Other features vary but may include signs of androgen excess — male distribution of body hair and muscle mass, facial hair growth, acne and, occasionally, obesity.

Prolactin-secreting pituitary tumor

Oligomenorrhea or amenorrhea may be the first sign of a prolactin-secreting pituitary tumor. Accompanying findings include unilateral or bilateral galactorrhea, infertility, loss of libido, and sparse pubic hair. Headache and visual field disturbances — such as diminished peripheral vision, blurred vision, diplopia, and hemianopia — signal tumor expansion.

Thyrotoxicosis

Thyrotoxicosis may produce oligomenorrhea along with reduced fertility. Cardinal findings include irritability, weight loss despite increased appetite, dyspnea, tachycardia, palpitations, diarrhea, tremors, diaphoresis, heat intolerance, an enlarged thyroid and, possibly, exophthalmos.

Other causes

Drugs

Drugs that increase androgen levels — such as corticosteroids, corticotropin, anabolic steroids, danazol (Danocrine), and injectable and implanted contraceptives — may cause oligomenorrhea. Hormonal contraceptives may be associated with delayed resumption of normal menses when their use is discontinued; however, 95% of women resume normal menses within 3 months. Other drugs that may cause oligomenorrhea include phenothiazine derivatives and amphetamines, and antihypertensive drugs, which increase prolactin levels.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Amenorrhea: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Adrenal tumor

In a patient with an adrenal tumor, amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with rapid onset of virilizing signs is usually indicative.

Adrenocortical hyperplasia

In a patient with adrenocortical hyperplasia, amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.

Adrenocortical hypofunction

Besides amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.

Anorexia nervosa

Anorexia nervosa, a psychological disorder, can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.

Congenital absence of the ovaries and uterus

Congenital absence of the ovaries and uterus results in primary amenorrhea and absence of secondary sex characteristics. Primary amenorrhea occurs with congenital absence of the uterus. The patient may not develop breasts.

Corpus luteum cysts

Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.

Hypothyroidism

Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.

Pituitary infarction

Pituitary infarction usually causes postpartum failure to lactate and failure to resume menses. Although associated signs and symptoms depend on the infarction’s severity, they include headaches, visual field defects, oculomotor palsies, and an altered level of consciousness. The patient may also lose pubic and axillary hair.

Pituitary tumor

Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache, vision disturbances such as bitemporal hemianopia, and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.

Polycystic ovary syndrome

In polycystic ovary syndrome, menarche typically occurs at a normal age and is followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea or periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.

Pseudoamenorrhea

With pseudoamenorrhea, an anatomic anomaly such as imperforate hymen obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.

Testicular feminization

Primary amenorrhea may signal testicular feminization, a form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.

Thyrotoxicosis

Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.

Turner’s syndrome

Primary amenorrhea and failure to develop secondary sex characteristics may signal Turner’s syndrome, a syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.

Other causes

Drugs

Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.

Radiation therapy

Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.

Surgery

Surgical removal of both ovaries or the uterus produces amenorrhea.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Oligomenorrhea: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Adrenal hyperplasia.With adrenal hyperplasia, oligomenorrhea may occur with signs of androgen excess, such as clitoral enlargement and male distribution of hair, fat, and muscle mass.

Anorexia nervosa.Anorexia nervosa may cause sporadic oligomenorrhea or amenorrhea. Its cardinal symptom, however, is a morbid fear of being fat associated with weight loss of more than 20% of ideal body weight. Typically, the patient displays dramatic skeletal muscle atrophy and loss of fatty tissue; dry or sparse scalp hair; lanugo on the face and body; and blotchy or sallow, dry skin. Other symptoms include constipation, a decreased libido, and sleep disturbances.

Diabetes mellitus.Oligomenorrhea may be an early sign in diabetes mellitus. In type 1 diabetes, the patient may have never had normal menses. Associated findings include excessive hunger, polydipsia, polyuria, weakness, fatigue, dry mucous membranes, poor skin turgor, irritability and emotional lability, and weight loss.

Hypothyroidism.Besides oligomenorrhea, hypothyroidism may result in fatigue; forgetfulness; cold intolerance; unexplained weight gain; constipation; bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails.

Prolactin-secreting pituitary tumor.Oligomenorrhea or amenorrhea may be the first sign of a prolactin-secreting pituitary tumor. Accompanying findings include unilateral or bilateral galactorrhea, infertility, loss of libido, and sparse pubic hair. Headache and visual field disturbances—such as diminished peripheral vision, blurred vision, diplopia, and hemianopia—signal tumor expansion.

Thyrotoxicosis.Thyrotoxicosis may produce oligomenorrhea along with reduced fertility. Cardinal findings include irritability, weight loss despite increased appetite, dyspnea, tachycardia, palpitations, diarrhea, tremors, diaphoresis, heat intolerance, an enlarged thyroid and, possibly, exophthalmos.

Other causes

Drugs.Drugs that increase androgen levels—such as corticosteroids, corticotropin, anabolic steroids, danocrine, and injectable and implanted hormonal contraceptives—may cause oligomenorrhea. Hormonal contraceptives may be associated with delayed resumption of normal menses when their use is discontinued; however, 95% of women resume normal menses within 3 months. Other drugs that may cause oligomenorrhea include phenothiazine derivatives and amphetamines, and antihypertensive drugs, which increase prolactin levels.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Amenorrhea: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Adrenal tumor.Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic personality changes. Asymmetrical ovarian enlargement in conjunction with the rapid onset of virilizing signs is usually indicative of an adrenal tumor.

Adrenocortical hyperplasia.Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.

Adrenocortical hypofunction.In addition to amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.

Amenorrhea-lactation disorders.Amenorrhea-lactationdisorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.

Anorexia nervosa.Anorexia nervosa can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, a blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.

Congenital absence of the ovaries.Congenital absence of the ovaries results in primary amenorrhea and the absence of secondary sex characteristics.

Congenital absence of the uterus.Primary amenorrhea occurs with congenital absence of the uterus. The patient may develop breasts.

Corpus luteum cysts.Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.

Hypothalamic tumor.In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.

Hypothyroidism.Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.

Mosaicism.Mosaicism results in primary amenorrhea and the absence of secondary sex characteristics.

Ovarian insensitivity to gonadotropins.A hormonal disturbance, ovarian insensitivity to gonadotropins leads to amenorrhea and an absence of secondary sex characteristics.

Pituitary tumor.Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache; visual disturbances, such as bitemporal hemianopsia; and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.

Polycystic ovary syndrome.Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.

Pseudoamenorrhea.An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.

Pseudocyesis.With pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.

Testicular feminization.Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.

Thyrotoxicosis.Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.

Turner's syndrome.Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.

Uterine hypoplasia.Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.

Other causes

Drugs.Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they're discontinued.

Radiation therapy.Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.

Surgery.Surgical removal of both ovaries or the uterus produces amenorrhea.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007


 » Next page: Symptoms of Amenorrhea

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