Evaluation of secondary amenorrhea

Last reviewed: 11 Sep 2025
Last updated: 02 Oct 2025

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
Full details

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
Full details

Contributors

Authors

Meir Jonathon Solnik, MD, MBA, FACOG, FACS
Meir Jonathon Solnik

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

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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

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