This Mind Map was created By Lina Al Harbi and it was revised and edited By Dr Arwa M Amin. The information of the mind-map are from: Chapter 96: Menstruation-Related Disorders, Pharmacotherapy: A Pathophysiologic Approach, 11e

1. AMENORRHEA
Amenorrhea is defined as no menstrual bleeding in a 90-day period.
Primary amenorrhea Secondary amenorrhea
absence of menses by age 15 years in
women who have never menstruated.
is the absence of menses for three
cycles or for 6 months in a
previously menstruating woman.
Abnormalities Involving:
(i) the hypothalamic–pituitary
axis resulting in endocrine
disturbances,
(ii) ovarian function or
(iii) outflow tract.
occurs more frequently in women
younger than 25 years with a
history of menstrual irregularities
and in those involved in
competitive athletics
due to the impact of disturbances
of the 1- (HPA) axis 2- (HPO)
axis.
Amenorrhea is not itself a diagnosis, but a sign of a disorder.
1- Anatomical causes, including pregnancy and uterine structural
abnormalities
2- Endocrine disturbances leading to chronic anovulation
3- Ovarian insufficiency/failure.
• Urine pregnancy test should be one of the first step in
evaluating amenorrhea.
Symptoms
• cessation of menses.
• complain of infertility, vaginal dryness, or
decreased libido.
Signs
• women with established menstruation 
Cessation of menses for more than 6 months.
• absence of menses by age 16 in the presence of
normal secondary sexual development,
• or absence of menses by age 14 in the absence of
normal secondary sexual development.
• Recent significant weight loss or weight gain.
• Presence of acne, hirsutism, hair loss, or
acanthosis nigricans may suggest androgen
excess.
Laboratory Tests
• Pregnancy test
• Serum FSH and LH
• Thyroid-stimulating hormone
• Prolactin
• If hyperandrogenic state (eg, PCOS) is suspected,
consider free and total testosterone,
dehydroepiandrosterone, fasting glucose, and fasting
lipid panel.
Other Diagnostic Tests
• Progesterone challenge to confirm functional
anatomy and adequate estrogenization.
• Pelvic ultrasound to evaluate for polycystic ovaries,
presence/absence of uterus, and/or structural
abnormalities of the reproductive tract organs.
▪ Desired Outcomes
o bone density preservation,
o bone loss prevention,
o ovulation restoration to improve fertility.
o Hypoestrogenism may affect quality of life via hot
flash induction (premature ovarian failure),
dyspareunia.
o in prepubertal females, Hypoestrogenism lack of
secondary sexual characteristics and absence of
menarche. Treatment is targeted at reversing these
effects.
▪ General Approach To Treatment
o proper identification of the disorder's underlying
cause so the appropriate intervention can be made.
o For patients experiencing amenorrhea secondary to
hypoestrogenic states, a diet rich in calcium and
vitamin D is essential to minimize any negative
impact on bone health.
Amenorrhea secondary to anorexia
may respond to weight gain.
In young women for whom
excessive exercise is an underlying
cause, reduction of exercise quantity
and intensity are important.
Functional Hypothalamic Amenorrhea (FHA)
Cognitive behavioral therapy to restore
ovarian function.
nutrition and/or modified exercise
intervention prior to use of pharmacotherapy
induced hyperprolactinemia-medicationIn
(Typical and Atypical antipsychotic,
antidepressant, MOA inhibitors, verapamil,
metoclopramide and domperidone) consider
alternative agents that do not inhibit dopamine
receptors or increase prolactin levels.
Anorexia nervosa, bulimia, intense exercise, leptin insufficiency and stress
This mind-map is created by Lina Al Harbi. Revised & edited By Dr. Arwa M. Amin. The information of the mind-map is based on Chapter 96: Menstruation-Related Disorders, Pharmacotherapy: A Pathophysiologic Approach, 11e