AMENORRHEA

Karmmanya Razahani Purnama

 CLASSIFICATION BASED ON ONSET

PRIMARY SECONDARY
Absence of menses at age 13 years when there is Absence of menstruation for three normal
no visible development of secondary sexual menstrual cycles.
characteristics or age 15 years in the presence of
normal secondary sexual characteristics.
DIAGNOSIS
Based on secondary sexual characteristics and
anatomical condition.
AMENORRHEA AMENORRHEA AMENORRHEA
without secondary with secondary sexual with secondary sexual
sexual characteristics characteristics and characteristics and
pelvic anatomy normal pelvic anatomy
abnormalities
 AMENORRHEA
WITHOUT
SECONDARY
SEXUAL
01. CHARACTERISTICS
HYPERGONADOTROPIC
HYPOGONADISM 01 02
Turner Syndrome Abnormal X Chromosome

A. Genetic Disorders Fibrotic ovaries (streak ovaries) Phenotype depends on X

chromosome deletion

05 03 04
Mosaicism Pure Gonadal Dysgenesis
Mixed Gonadal Dysgenesis
Ambiguous genitalia w/ streak 2/more set of cells in their body Abnormal embryology of gonad
ovaries
HYPERGONADOTROPIC
HYPOGONADISM 01 02
Congenital Lipoid Adrenal 17-ahydroxylase and 17,20-lyase
Hyperplasia deficiencies
B. Enzyme Deficiencies

03 04
Aromatase Deficiency Galactosemia
HYPERGONADOTROPIC
HYPOGONADISM 01
LH Receptor mutation

C. Gonadotropin Receptor
Fibrotic ovaries (streak ovaries)

Mutations
02
FSH Receptor Mutation
2/more set of cells in their body
HYPERGONADOTROPIC
HYPOGONADISM

D. Primary Ovarian Failure

Severe damage to ovaries (chemotherapeutic & radiation)
that caused ovarian insufficiency
HYPOGONADOTROPIC
HYPOGONADISM 01 02
Physiologic Delay
Delayed reactivation of GnRH
pulse generator.
Kallmann Syndrome
Hypothalamic cause makes
pulsatile secretion of GnRH
insufficient.

05 03 04
CNS Tumors Genetic
Others
Malnutrition, malabsorption, weight loss, GnRH defficiency 5(alfa)-reductase deficiency,
excessive exercise, chronic disease, neoplasias, GnRH receptor mutations, FSH
marijuana use. deficiency.
 AMENORRHEA
WITH
SECONDARY
SEXUAL
CHARACTERISTICS
02. & PELVIC ANATOMY
ABNORMALITIES
OUTFLOW &
MULLERIAN ANOMALIES 01 02
Transverse Blockages of Mullerian
Mullerian Anomalies
System
Imperforate hymen, transverse Mullerian tract developmental
vaginal septum, absence of failure during embryonic growth.
cervix or vagina.

03
Cause cyclic pain and blockage
of blood cause hematocolpos,
hematometria, hemoperitoneum,
endometriosis.

No Functioning Endometrium
Asherman syndrome =
intrauterine adhesions can be
caused by surgery or infections
(scarring as its risk factor)
ANDROGEN
INSENSITIVITY
Phenotypically woman but genotypically
male. Testes rather than ovary present

TRUE
HEMAPHRODITISM
Both male and female gonadal tissue
are present.
 AMENORRHEA
WITH
SECONDARY
SEXUAL
CHARACTERISTICS
03. & NORMAL PELVIC
ANATOMY
 Pregnancy PCOS Hyperprolactinemia
Despite being red, Mars is a cold place, Hyperandrogenism, ovulatory Prolactin naik, abnormal GnRH
not hot. It’s full of iron oxide dust dysfunction and plycystic ovaries secretion jadi anovulation

Primary Ovarian Pituitary and

Insufficiency Hypothalamic Eating Disorders
Premature ovarian failure, unknown Lesions Altered hormonal pattern
cause.
Weight Loss and Excercise Stress
Dieting LH and GnRH pulses decrease Neuromodulation in hypothalamic
GnRH secretion.

Obesity Other Hormonal

Fat cells increase, aromatization of
androgen to estrogen increase Factors
Diagnosis Algorithm
OTHER MENSTRUAL
ABNORMALITIES
DYSMENORRHEA
PRIMARY: Recurrent lower abdominal pain
shortly before or during menstruation in the
absence of pathologic findings.

SECONDARY: Recurrent lower abdominal pain

shortly before or during menstruation due to
underlying condition (endometriosis, IUD, etc).
ABNORMAL
UTERINE
BLEEDING
1. Berek & Novak’s Gynecology
(15th Ed)
2. Williams Gynecology (3rd Ed)
SOURCES
3. https://www.amboss.com/us/kn
owledge/The_menstrual_cycle_
and_menstrual_cycle_abnorma
lities