nonmenstrualia

Nonmenstrualia is a term used in some medical contexts to denote the absence of menstrual bleeding in individuals who would normally be expected to menstruate. In practice, it is often treated as synonymous with amenorrhea, though terminology can vary by source. It can refer to the complete absence of menses (primary nonmenstrualia) or the loss of menses after they have begun (secondary nonmenstrualia).

Primary nonmenstrualia refers to failure to begin menstruation by an appropriate age, typically with consideration of secondary sexual characteristics. Secondary nonmenstrualia describes the cessation of menses for several consecutive cycles or months in someone with prior normal menses.

Causes of nonmenstrualia are diverse and are commonly grouped into categories such as hypothalamic/pituitary, ovarian, uterine/outflow tract, systemic illness, and medication effects. Functional hypothalamic causes include stress, weight loss, or excessive exercise. Hyperprolactinemia, thyroid disorders, or pituitary tumors can suppress ovulation. Ovarian causes include premature ovarian insufficiency or other ovarian failures. Uterine or outflow tract problems (for example, scarring) can prevent menses. Pregnancy is also a frequent cause of secondary nonmenstrualia. Medications (such as certain antipsychotics or chemotherapy) and chronic illness can contribute as well.

Evaluation typically begins with pregnancy testing, followed by history and physical examination, and targeted laboratory tests (hormone levels such as FSH, LH, estradiol, prolactin, and thyroid function). Imaging or endoscopic assessment may be indicated based on suspected underlying issues.

Management depends on the underlying cause and patient goals, including lifestyle adjustments, treatment of hormonal imbalances, or hormone therapy to regulate or replace menstrual function. When pregnancy is not desired, contraception or fertility counseling may be relevant. The prognosis varies with the cause and the individual's overall health.