Evaluation of secondary amenorrhea

Last reviewed: 15 Apr 2025
Last updated: 18 Feb 2025

Summary

Differentials

Common

  • Eating disorders or female athlete triad
  • Emotional or physical stress
  • Postcontraception with depot medroxyprogesterone
  • Hyperprolactinemia
  • Polycystic ovary syndrome (PCOS)
  • Idiopathic premature ovarian failure
  • Postchemoradiation ovarian failure
  • 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 failure
  • Androgen-producing adrenal tumor
  • Cushing syndrome
  • Asherman syndrome
  • Drug-induced
Full details

Contributors

Authors

Meir Jonathon Solnik, MD
Meir Jonathon Solnik

Associate Professor of Obstetrics and Gynaecology

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 is a consultant for Pfizer, Abbvie, and Integra Life Sciences. He has previously been a consultant for Medtronic. He is an advisor for Felix Health.

Peer reviewers

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.

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

Goodman LR, Warren MP. The female athlete and menstrual function. Curr Opin Obstet Gynecol. 2005 Oct;17(5):466-70. Abstract

Wellons MF, Weeber KM, Rebar RW. Amenorrhea. In: Falcone T, Hurd WW, eds. Clinical reproductive medicine and surgery: a practical guide. 3rd ed. Heidelberg: Springer International Publishing; 2017:109-22.

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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