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Differential Diagnosis of Amenorrhea
• Uterovaginal abnormalities
• Pregnancy
• Pituitary dysfunction: neoplasm, postpartum hemorrhage, surgery, radiotherapy
• Ovarian dysfunction: gonadal dysgenesis, 17α-hydroxylase deficiency, premature ovarian failure, polycystic ovarian disease, gonadal stromal tumors
• Other: metabolic diseases (liver, kidney), malnutrition, rapid weight loss, exogenous obesity, endocrine abnormalities (Cushing’s syndrome, Graves’ disease, hypothyroidism)
• Hypothalamic dysfunction: defective synthesis or release of luteinizing hormone–releasing hormone (LH-RH), anorexia nervosa, stress, exercise
• Early menopause
• Congenital: imperforate hymen, imperforate cervix, imperforate or absent vagina, müllerian agenesis
• Acquired: destruction of endometrium with curettage (Asherman’s syndrome), closure of cervix or vagina caused by traumatic injury, hysterectomy
• Uterovaginal abnormalities
• Pregnancy
• Pituitary dysfunction: neoplasm, postpartum hemorrhage, surgery, radiotherapy
• Ovarian dysfunction: gonadal dysgenesis, 17α-hydroxylase deficiency, premature ovarian failure, polycystic ovarian disease, gonadal stromal tumors
• Other: metabolic diseases (liver, kidney), malnutrition, rapid weight loss, exogenous obesity, endocrine abnormalities (Cushing’s syndrome, Graves’ disease, hypothyroidism)
• Hypothalamic dysfunction: defective synthesis or release of luteinizing hormone–releasing hormone (LH-RH), anorexia nervosa, stress, exercise
• Early menopause
• Congenital: imperforate hymen, imperforate cervix, imperforate or absent vagina, müllerian agenesis
• Acquired: destruction of endometrium with curettage (Asherman’s syndrome), closure of cervix or vagina caused by traumatic injury, hysterectomy
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