1. Amenorrhea is defined as the absence of menstruation and can be classified as physiological, pathological, primary, or secondary. 2. Causes of amenorrhea include developmental defects of the genital tract, abnormalities of the hypothalamic-pituitary-ovarian axis, chromosomal abnormalities, and diseases of the thyroid or adrenal glands. 3. Treatment depends on the underlying cause, and may include vaginoplasty or gonadectomy for developmental anomalies, hormone replacement therapy for chromosomal or hormonal issues, and treatment of underlying diseases in metabolic or systemic illness cases.

1. DR ANITA RAMESH
MD,OBGY

2.  Amenorrhea means absence of menstruation
 TYPES
Physiological amenorrhea
Pathological amenorrhea
Primary amenorrhea
Secondary amenorrhea

3.  Absence of menses by the age of 14 years
with no secondary sexual characters
0R
 Absence of menses by the age of 16 years
irrespective of development of secondary
sexual characters

4.  Absence of menses for 6 months or absence
of atleast 3 of the previous 3 cycles

5.  3% to 4%
 About 10% to 20% of those with infertility
have amenorrhea

6.  Normal chromosomal pattern
 Co ordinated HPO axis
 Anatomical presence & patency of outflow
tract
 Responsive endometrium
 Active thyroid & adrenal glands

8.  Before puberty
 Pregnancy
 Lactation
 menopause

12.  Amenorrhea
 Periodic pain in the lower abdomen
 Abdominal lump
 Retention of urine

13.  Imperforate hymen:cruciate incision over
bulging hymen
 Cervical stenosis:cervical dilatation
 Transverse vaginal septum:excision of septum

14.  Hypergonadotropic hypogonadism(43%)
 Developmental defects of genital tract(30%)
 Hyogonatotropic hypogonadism(27%)
 Abnormal chromosomal pattern
 Dysfunction of thyroid or adrenal
gland(adrenogenital syndrome,cretinism)
 Metabolic disorders(juvenile diabetes)
 Systemic illnesses(malnutition,TB,weight
loss,anaemia)
 Unresponsive endometrium:uterine synchiae
due to TB

15.  Primary ovarian failure
 Resistant ovarian syndrome
 Galactosemia
 Enzyme deficiency:17 alpa hydroxylase
deficiency

16.  Mullerian agenesis or dysgenesis
 Imperforate hymen
 Transverse vaginal septum
 Atresia of upper third of vagina & cervix
 Complete absence of vagina
 Absence of uterus(MRKH)

17.  Constitutional delay:delayed GnRH pulse
activation
 HPO AXIS DYSFUNCTION:stress,weight
loss,excessive exercise,chronic
disease(TB),anorexia nervosa
 Kallmans disease(inadequate GnRH pulse
secretion
 CNS TUMOURS:craniophayngioma(reduced
Gnrh RELEASE

18.  Turner”s syndrome(45X or various mosaics)
 Pure gonadal
dysgenesis(46XX…phenotypically female with
streak gonads)
 Androgen insensitivity syndrome(testicular
feministion syndrome…46XY)
 Partial deletions of X chromosome

21.  DEVELOPMENTAL ANOMALIES
ABSENT VAGINA:Vaginoplasty before
marriage
 CHROMOSOMAL ABNORMALITIES
Turner”s syndrome:short course of E+P for
breast development
XY Gonadal dysgenesis:gonads to be
removed for preventing seminoma or
dysgerminoma

22.  Androgen insensitivity syndrome:Reared as
female only & removal of gonads.HRT with CEE
0.625 mg continued for maintainence of
secondary sexual characters
 HPO Axis defect:
Constitutional delay:reassure patient or can be
induced using E+P
Kallman”s syndrome:periods induced with
pulsatile GnRH administration
HP tumours like craniopharyngioma needs
excision or radiotheraphy

23.  Thyroid & adrenal dysfunction:
1. Cretinism:thyroid replacement theraphy
2. Adrenogenital syndrome with enlarged
clitoris needs clitoroplasty &
corticosteriods for prolonged theraphy
3. 17 alpha hydroxylase
deficiency:corticosteroid replacement
theraphy
4. Prolactinomas:dopamine agonists

24.  Metabolic & nutritional
1. Diabetes:antidiabetics
2. TB:Anti TB drugs
3. Correction of weight loss
4. Reduction of stress
 Unresponsive endometrium due to TB
Anti TB drugs,adhesiolysis & high dose E+P