Summary
Differentials
Common
- Functional hypothalamic amenorrhoea (overexercise, disordered eating and/or stress induced)
- Postcontraception with depot medroxyprogesterone
- Hyperprolactinemia
- Polycystic ovary syndrome (PCOS)
- Idiopathic premature ovarian insufficiency
- Postchemoradiation ovarian insufficiency
- Chromosomal abnormality (Fragile X carrier, Turner syndrome mosaic)
- Nonclassic congenital adrenal hyperplasia
- Hypothyroidism
Uncommon
- Malnutrition or chronic disease state
- Empty sella syndrome
- Sheehan syndrome (postpartum pituitary necrosis)
- Postencephalitis
- Androgen-producing ovarian tumor
- Autoimmune premature ovarian insufficiency
- Androgen-producing adrenal tumor
- Cushing syndrome
- Asherman syndrome
- Drug-induced
Contributors
Authors
Meir Jonathon Solnik, MD, MBA, FACOG, FACS

Professor of Obstetrics and Gynaecology and Medical Imaging (by cross-appointment)
Temerty School of Medicine at the University of Toronto Faculty of Medicine
Head of Gynaecology and Minimally Invasive Surgery
Sinai Health System
Site Chief of Gynaecology
Women’s College Hospital
Toronto
Canada
Disclosures
MJS has been on advisory boards for Abbvie, Pfizer, and Integra Health. He holds stock options in Felix Health.
Peer reviewers
Chrisandra Shufelt, MD, MS
Professor and Chair
Division of General Internal Medicine
Associate Director
Women's Health Research Center
Mayo Clinic
Jacksonville
FL
Disclosures
CS declares that she receives funding from the National Institutes of Health (NIH) relating to secondary amenorrhea.
Joseph S. Sanfilippo, MD, MBA
Professor
Department of Obstetrics, Gynecology, and Reproductive Sciences
Vice Chairman
Reproductive Sciences
Director
Division of Reproductive Endocrinology and Infertility
University of Pittsburgh
Pittsburgh
PA
Disclosures
JSS declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea: a committee opinion. Fertil Steril. 2024 Jul;122(1):52-61.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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