amenorré

Amenorré, or amenorrhée, denotes the absence of menstrual bleeding in individuals of reproductive age. It is a clinical finding rather than a disease, and may reflect normal physiological states (pregnancy, lactation, menopause) or a range of pathologic processes affecting the hypothalamic–pituitary–ovarian–uterine axis. It is not limited to a single cause and requires evaluation to determine the underlying reason and appropriate management.

There are two main types: primary and secondary. Primary amenorrhea is the failure to initiate menses by age 15 with normal secondary sexual characteristics, or by age 13 without them. Secondary amenorrhea is the loss of menses for 3 consecutive cycles or 6 months in someone who previously menstruated.

Common causes can be grouped broadly: pregnancy or lactation; functional hypothalamic amenorrhea due to stress, weight loss, or excessive exercise; pituitary disorders such as hyperprolactinemia; thyroid disease; ovarian conditions including polycystic ovary syndrome and premature (primary) ovarian insufficiency; uterine or outflow tract issues such as Asherman syndrome; genetic or congenital conditions; and medications that suppress ovulation or alter hormones.

Diagnosis typically begins with excluding pregnancy, followed by history, physical examination, and targeted investigations. Laboratory tests may include hCG, FSH, LH, estradiol, prolactin, and TSH; additional tests or imaging (pelvic ultrasound, MRI of the pituitary) may be indicated. Bone density assessment can be considered in chronic hypoestrogenic states.

Management depends on the underlying cause and reproductive goals. Treatments may involve addressing systemic disorders, pharmacologic regulation of cycles (for example hormonal contraceptives or progestins), fertility-focused therapies for ovulatory disorders, or surgical intervention for structural problems. Functional etiologies often improve with nutritional rehabilitation and lifestyle changes.