Differential Diagnosis For Secondary Amenorrhea: Disease Categories

OVERVIEW

This page is dedicated to covering the differential diagnosis for secondary amenorrhea. This differential will be organized by disease categories.

WHAT ARE THE MAJOR DISEASE CATEGORIES?

When thinking about the differential for secondary amenorrhea the following disease categories come to mind:

• Hypogonadotropic hypogonadism
• Hypergonadotropic hypogonadism
• Other

HYPOGONADOTROPIC HYPOGONADISM

Hypogonadotropic hypogonadism refers to a state where hypogonadism in the patient is caused by a deficiency of gonadotropins (such as FSH or LH). Some examples of this (that can cause secondary amenorrhea) include issues that involve either the hypothalamus or the pituitary glands.

Hypothalamus dysfunction:

• Kallman syndrome (the failure of the hypothalamus to release GnRH)
• Excessive physical training
• Anorexia nervosa
• Marijuana use
• Starvation
• Stress
• Major depressive disorder
• Chronic illness

Pituitary dysfunction:

• Sheehan syndrome (postpartum hypopituitarism)
• Panhypopituitarism
• Isolated gonadotropin deficiency
• Hemosiderosis (primarily fromthalassemia major)

HYPERGONADOTROPHIC HYPOGONADISM

Hypergonadotropic hypogonadism refers to a state where hypogonadism in the patient is present in the setting of elevated gonadotropins (such as FSH or LH). Some examples of this (that can cause secondary amenorrhea) include issues that involve either the adrenal glands, or the gonads themselves.

Gonadal dysfunction:

• Idiomatic premature ovarian failure
• Radiation to the gonads
• Autoimmune ovarian failure
• Post infection (mumps)
• Oophorectomy

OTHER CAUSES OF SECONDARY AMENORRHEA

Here are some other causes of secondary amenorrhea:

• Pregnancy: this can of course be a very common cause of secondary amenorrhea.

Medication induced: Medications can of course cause changes in hormone signaling that may result in amenorrhea. Here are some examples:

• Levonorgestrel: this progestin containing IUD commonly can cause amenorrhea. This can be used to improve anemia and abnormal uterine bleeding.
• Depot medroxyprogesterone acetate (DMPA): this medication commonly causes amenorrhea in patients (especially those who have used it for longer then 1 year).

Page Updated: 10.02.2016