Nawaz Gul, Rogol Alan D., Jenkins Suzanne M., Kuehl Daphne
Southern Illinois University
Typically, the female menstrual cycle comprises a 28 to 30-day cycle containing 2 phases: the proliferative and secretory phases. The uterine lining sheds at the end of the cycle, known as menstruation.[1][2][3] Throughout each stage of a woman's reproductive life cycle, from menarche to menopause, there may be variations in their menstrual cycle's length and amount secondary to many causes. This variation may be within the normal range or pathologic. Particularly during stages of the reproductive cycle (eg, menarche and perimenopause), when longer intervals between menstrual cycles commonly occur, clinicians may be unsure of the appropriate diagnostic studies or whether an evaluation is even indicated. Amenorrhea is abnormal uterine bleeding characterized by the absence of menstruation in a female of reproductive age, 12 to 52 years on average. It 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. Patients meeting the criteria for either primary or secondary amenorrhea warrant an evaluation. However, an evaluation for delayed puberty is indicated in adolescents aged 13 years with primary amenorrhea and no breast development. There are numerous potential etiologies of amenorrhea. Most underlying causes can be classified into general groups: outflow tract abnormalities; primary ovarian insufficiency; hypothalamic or pituitary disorders; other endocrine gland disorders; and physiologic or medication induced. When evaluating a patient with amenorrhea, a systematic approach should be used to consider each potential etiology. 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.
通常情况下，女性月经al期。子宫内膜在周期结束时脱落，即月经。在女性生殖生命周期的每个阶段，从初潮到绝经，由于多种原因，其月经周期的长度和经量可能会有所变化。这种变化可能在正常范围内，也可能是病理性的。特别是在生殖周期的某些阶段（如初潮和围绝经期），月经周期间隔通常会变长，临床医生可能不确定合适的诊断性检查，甚至不确定是否需要进行评估。闭经是指育龄女性（平均年龄12至52岁）出现的异常子宫出血，其特征为月经缺失。闭经可分为原发性闭经和继发性闭经。原发性闭经定义为15岁仍无月经史或乳房发育后3年仍无月经；继发性闭经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。符合原发性或继发性闭经标准的患者需要进行评估。然而，13岁原发性闭经且无乳房发育的青少年需要进行青春期延迟的评估。闭经有许多潜在病因。大多数潜在病因可分为以下几类：生殖道异常；原发性卵巢功能不全；下丘脑或垂体疾病；其他内分泌腺疾病；以及生理或药物诱导因素。评估闭经患者时，应采用系统的方法来考虑每种潜在病因。初始检查通常包括全面病史和体格检查、尿妊娠试验、血清激素检测及盆腔影像学检查。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、手术及心理健康服务。
