Journal List > Korean J Obstet Gynecol > v.53(7) > 1006436

Rhee: Diagnostic approach of amenorrhea

Abstract

A complete interaction in the hypothalamic-pituitary-ovary-uterus (H-P-O-U) axis must take place in order for normal menstruation occurs. If any of the components in the H-P-O-U axis are nonfunctional, amenorrhea could occur. The prevalence of amenorrhea not due to pregnancy or lactation is approximately 3% to 4% in reproductive women. Because there are many causes of amenorrhea, the clinicians should be concerned with array of potential diseases and disorders involving unfamiliar organ systems, some carrying morbid and even lethal consequences for the patients. To explore the causes of amenorrhea, thorough evaluation of H-P-O-U axis and endocrinologic profiles are needed. The etiologic diagnosis is almost always possible with proceeding step by step approaches.

Figures and Tables

Fig. 1
Diagnostic approach in patient with amenorrhea. M-R-K-H: Mayer-Rokitansky-Küster-Hauser syndrome, AIS: androgen insensitivity syndrome, LH: luteinizing hormone, FSH: follicle stimulating hormone, TSH: thyroid stimulating hormone, DHEA-S: dehydroepiandrosterone sulfate, POF: premature ovarian failure, PCOS: polycystic ovary syndrome.
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Table 1
Pituitary and hypothalamic lesions
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Table 2
Etiologic diagnosis in patients with primary amenorrhea19,40
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AIS: androgen insensitivity syndrome, M-R-K-H: Mayer-Rokitansky-Küster-Hauser syndrome, PCOS: polycystic ovary syndrome.

Table 3
Common causes of secondary amenorrhea (From Practice Committee of American Society for Reproductive Medicine. Fertil Steril 2008; 90: S219-25, with permission from Elsevier).40
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FSH: follicle stimulating hormone, PCOS: polycystic ovary syndrome, CAH: congenital adrenal hyperplasia.

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