Amenorrhea is defined as the absence of menses. Primary amenorrhea occurs when menarche has not occurred by age seventeen. Secondary amenorrhea is the cessation of menses for three cycles in a non-pregnant woman.
Causes of primary amenorrhea include: Imperforate hymen; Agenesis of the uterus and upper 2/3 of the vagina; Turner's syndrome; Constitutional delay; Secondary amenorrhea; Physiological - pregnancy, corpus luteal cyst, breast-feeding, menopause; Suppression of the hypothalamic-pituitary axis - post pill amenorrhea, stress, intercurrent illness, weight loss, low body mass index; Pituitary disease - ablation of the pituitary gland, Sheehan's syndrome, prolactinoma; Uncontrolled endocrinopathies - diabetes, hypo- or hyperthyroidism; Polycystic ovarian disease (POD), (Stein-Leventhal syndrome); Chemotherapy; Pelvic irradiation; Endometrial ablation (Asherman's syndrome); Drug therapy - systemic steroids, danazol, GRH-RH analogs; and Premature ovarian failure.
Risk factors for amenorrhea include: Over-training (e.g., long-distance runner, ballet dancer); Eating disorders; and Psycho-social crisis.
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