Gasner Adi, Rehman Anis
McMaster University
District Endocrine/Sentara Northern Virginia Medical Center
Amenorrhea is abnormal uterine bleeding characterized by the absence of menstruation in a female of reproductive age. Amenorrhea can be classified as either primary or secondary amenorrhea. Primary amenorrhea is defined as having no history of menstruation by the age of 15 years or 3 years after thelarche; secondary amenorrhea is defined as the absence of menses for ≥3 months in a woman with previously regular menstrual cycles or ≥6 months in any woman with at least one previous spontaneous menstruation. The median age of menarche is approximately 12.4 years, though this varies somewhat by patient-specific factors (eg, ethnicity, weight, and nutrition status). Menarche typically occurs within 2 to 3 years of initial breast development, which occurs between the ages of 8 and 10 years, known as thelarche. Patients meeting the criteria for either primary or secondary amenorrhea warrant an evaluation. However, an evaluation for delayed puberty is also indicated in adolescents aged 13 years with primary amenorrhea and no breast development or other secondary sex characteristics (eg, pubic and axillary hair). Most underlying causes of primary amenorrhea can be classified into general groups: anatomic and sexual development abnormalities, ovarian insufficiency, hypothalamic or pituitary disorders, and other endocrine gland disorders. Physiology and medications may also cause primary amenorrhea; however, they are more commonly associated with secondary amenorrhea. The initial work-up usually includes a comprehensive history and physical examination, a urine pregnancy test, serum hormone testing, and pelvic imaging. Additional testing may also be indicated based on the clinical presentation. Treatment depends on the underlying etiology and may include lifestyle interventions, hormone therapy or other medications, surgery, and mental health services. Therefore, all healthcare professionals should strive to enhance their competence when managing primary amenorrhea and equip themselves with updated knowledge, skills, and strategies for timely diagnosis, effective interventions, and improved care coordination, leading to better patient outcomes.
闭经是一种异常子宫出血，其特征为处于生育年龄的女性无月经来潮。闭经可分为原发性闭经和继发性闭经。原发性闭经的定义为15岁仍无月经初潮或乳房发育后3年仍无月经；继发性闭经的定义为既往月经周期规律的女性停经≥3个月，或既往至少有一次自然月经的女性停经≥6个月。月经初潮的中位年龄约为12.4岁，不过这会因患者的特定因素（如种族、体重和营养状况）而有所不同。月经初潮通常在最初乳房发育后的2至3年内出现，乳房发育发生在8至10岁之间，称为乳房初现。符合原发性或继发性闭经标准的患者需要进行评估。然而，对于13岁且有原发性闭经且无乳房发育或其他第二性征（如阴毛和腋毛）的青少年，也需要进行青春期延迟的评估。原发性闭经的大多数潜在病因可分为一般类别：解剖和性发育异常、卵巢功能不全、下丘脑或垂体疾病以及其他内分泌腺疾病。生理因素和药物也可能导致原发性闭经；然而，它们更常与继发性闭经相关。初始检查通常包括全面的病史和体格检查、尿妊娠试验、血清激素检测和盆腔影像学检查。根据临床表现可能还需要进行其他检查。治疗取决于潜在病因，可能包括生活方式干预、激素治疗或其他药物治疗、手术以及心理健康服务。因此，所有医疗保健专业人员在管理原发性闭经时应努力提高自身能力，并掌握最新的知识、技能和策略，以便及时诊断、有效干预并改善护理协调，从而为患者带来更好的治疗效果。
