Disease Risk factors Causes Symptoms Diagnostic tests Treatment

Amenorrhea  Anorexia Primary: Absent menstrual period  Evaluation of external  Hormone

nervosa  Turner syndrome (ovaries replaced by genitalia. replacem
 Diet streak gonads/functionless fibrous tissue Primary:  Pregnancy test therapy C
 Stress  accelerated ovarian follicle depletion  no menses at 16 y.o.  Transabdominal US: Turner sy
 Turner  FSH + LH ↑) independently of the for structural issues + PCOS +
syndrome  Müllerian agenesis (müllerian duct presence of secondary  Evaluation of BMI Prematur
 Müllerian system doesn’t develop properly  this sexual characteristics  Hormonal tests: ovarian fa
agenesis system is responsible for development of  no menses at 14 y.o. w/h - LH  Dopamine
 Pregnancy uterus, cervix, 2/3rds vagina but the the absence of secondary - FSH agonists e
 PCOs ovaries develop normally in this individual sexual characteristics - Estrogen Cabergoli
 Prolactinoma  FSH + LH normal)  no menses for 4 y. after - Prolactin Prolactino
 Androgen insensitivity syndrome the beginning of puberty - Testosterone  Surgery:
(biologically male 46, XY karyotype,  Turner syndrome: short - Sexual hormone intrauteri
androgen receptors don’t respond to stature, absent secondary sex binding globulin adhesions
testosterone, don’t have uterus, fallopian characteristics, wide or (SHBG) removal +
tubes, ovaries  absence of menses  webbed neck - Suprarenal gland correct st
FSH + LH normal)  Müllerian agenesis: hormones issues; M
 Kallmann syndrome (neurons fail to dyspareunia, infertility - Thyroid hormones agenesis
migrate from the nose region to  Androgen insensitivity (TSH)  Psychothe
hypothalamus  ↓ GnRH, FSH, LH  ↓ syndrome: sparse body hair,  Karyotype for: Turner  Treatmen
estrogen  puberty doesn’t start or little – no pubertal acne syndrome + Androgen the relate
incomplete)  Kallmann syndrome: insensitivity syndrome fertility is
Secondary: anosmia  Hysteroscopy: gonadotro
 Pregnancy intrauterine adhesions therapy
 Functional hypothalamic amenorrhea (↓ Secondary: visualization
GnRH secretion  ↓ FSH, LH, estrogen)  no menses for ≥3 months
this can be caused by weight loss – if regular cycle
anorexia, nutritional deficiencies,  no menses for ≥6 months
strenuous exercise, severe w/h irregular cycle
 physical/emotional stress  Functional hypothalamic
 PCOS (affects hypothalamic – pituitary – amenorrhea due to anorexia:
ovarian axis  imbalance between LH + ↓ weight, ↓ bone density 
FSH levels: no ovulation  progesterone fractures
doesn’t ↑ enough  no inhibition of LH  PCOS: ↑↑↑ testosterone
 ↑↑ LH: FSH  post ovulatory ↑ & ↓  hirsutism
in progesterone  no menstruation )  Prolactinoma:
 Hyperprolactinemia (excessive prolactin galactorrhea
secretion) +  Premature ovarian failure:
 Prolactinoma (benign pituitary tumor)  hot flashes, vaginal dryness
high prolactin inhibits GnRH  inhibits  Intrauterine adhesions:
ovulation + menstruation infertility
 Hypothyroidism (↓ thyroid hormones 
hypothalamus releases more TRH +
pituitary releases more TSH  TRH
causes prolactin release 
hyperprolactinemia & amenorrhea occur)
 Premature ovarian failure (ovarian
follicles undergo accelerated atresia 
depleted before age 40  early
menopause  (↓ serum estrogen & ↑
FSH & ↑ LH)
 Intrauterine adhesions (structural cause:
when there’s scar tissue in intrauterine
cavity due to uterine instrumentation
no functional endometrium
left/endometrium becomes refractory to
hormonal stimulation)