Endocrine causes of amenorrhea.

Amenorrhea is a symptom of a variety of disorders and dysfunctions. It is important for the primary care practitioner to have an understanding of what constitutes normal function and of when to begin a diagnostic assessment of women with amenorrhea. Definitions and the basic principles of menstrual function are reviewed. Causes of amenorrhea are presented, including disorders of the uterus, disorders of the ovary, disorders of the anterior pituitary, and disorders of the central nervous system. The hypothalamic-pituitary-ovarian-uterine axis is used as a framework for the differential diagnosis of amenorrhea. A detailed process for assessing patients with amenorrhea is offered. Components of a amenorrheic-specific history, including menstrual, sexual and contraceptive, life-style, family, and medical histories, are reviewed. A step-by-step laboratory assessment is presented. Management of amenorrhea and health promotion strategies are discussed. The role of primary practitioners caring for amenorrheic women is outlined.