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Types of amenorrhoea is diagnosed based on several factors which include the age of onset, and level of hormonal involvement.
Age of onset
There are two types of amenorrhea: primary and secondary amenorrhea. Primary amenorrhoea is the absence of menstruation in a woman by the age of 16. Also, as pubertal changes precede the first period, menarche, women who have no sign of thelarche or pubarche and thus are without evidence of initiation of puberty by the age of 14 have primary amenorrhoea. (Reference: Speroff L et al, Clinical Gynecologic Endocrinology and Infertility, 1999)
Secondary amenorrhoea is where an established menstruation has ceased - for three months in a woman with a history of regular cyclic bleeding, or six months in a woman with a history of irregular periods.
Primary amenorrhoea
1. Gonadal dysgenesis, including Turner Syndrome.
2. Mullerian agenesis (Mayer-von-Rokitansky-Ku"ster-Hauser syndrome (MRKH)).
3. Androgen insensitivity syndrome.
4. Delay in hypothalamic-pituitary maturation.
5. Olfacto-genital dysplasia, Kallmann syndrome.
6. Vaginal obstruction, cryptomenorrhea, imperforate hymen.
7. Receptor abnormalities for FSH, LH.
8. Specific forms of congenital adrenal hyperplasia
9. Swyer syndrome
10. Galactosemia
11. Aromatase deficiency
12. Prader-Willi syndrome
13. Anorexia Nervosa
Secondary amenorrhoea
1. Pregnancy
2. Anovulation
3. Menopause
4. Premature menopause
5. Hypothalamic-pituitary dysfunction, including
1. Exercise amenorrhoea, related to excessive physical exercise
2. Stress amenorrhoea,
3. Eating disorders and weight loss (obesity, anorexia nervosa, or bulimia)
6. Hyperprolactinemia (elevated prolactin levels)
7. Polycystic ovary syndrome (PCO-S)
8. Androgen producing tumor (i.e arrhenoblastoma)
9. Intrauterine adhesions (Asherman's Syndrome)
10. Thyroid dysfunction
11. Hemochromatosis
12. Drug-induced
Hormonal involvement
Hypogonadotropic amenorrhoea refers to conditions where there are very low levels of serum FSH and LH. Generally, inadequate levels of these hormones lead to inadequately stimulated ovaries who then fail to produce enough estrogen to stimulate the endometrium (uterine lining), hence amenorrhoea. This is typical for conditions of pubertal delay, hypothalamic or pituitary dysfunction. In general, women with hypogonadotropic amenorrhoea are potentially fertile.
Hypergonadotropic amenorrhoea refers to conditions with high levels of FSH (and LH). FSH levels are typically in the menopausal range. This implies that the ovary or gonad does not respond to pituitary stimulation. Gonadal dysgenesis or premature menopause are possible causes. Chromosome testing is usually indicated in younger individuals with hypergonadotropic amenorrhoea.
In normogonadotropic amenorrhoea, FSH levels are in the normal range. This would suggest that the hypothalamic-pituitary-ovarian axis is functional. Amenorrhoea may be due to outflow obstruction, or abnormal ovarian regulation or excess androgens as seen in polycystic ovary syndrome.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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