chapter  4
40 Pages

Pathology

Allwomenwhoentermenopauseexperienceamenorrheaunlesstheyreceive

hormonereplacementtherapy(HRT).Inpremenopausalwomen,amenor-

rheaunrelatedtopregnancy,lactation,ordruginterventionssuchascon-

tinuousprogestogensorgonadotropinreleasinghormone(GnRH)analogs,

isapathologicalphenomenonwithimplicationsforfertility,psychological

healthandbonestability.Amenorrheamaybethemanifestingfeatureofa

widearrayofanatomicandendocrineabnormalities.Amenorrheacanoccur

asprimaryamenorrhea,i.e.withnohistoryofmenstruation,orassecond-

aryamenorrhea,i.e.withahistoryofmenstruation.Thefourmostcommon

causesofprimaryamenorrheaare:

•Ovarianfailure(48.5%)

•Congenitalabsenceoftheuterusandvagina(16.2%)

•GnRHdeficiency(8.3%)

•Constitutionaldelayofpuberty(6.0%) 1

InordertoclassifYthevariouscausesofsecondaryanovulation,theWorld

HealthOrganization(WHO)hasestablishedawidelyusedclassification.

Thisclassificationcomprisesdifferentsubgroupsofovarianinsufficiency

andisconsideredbymanyexpertstobeausefultoolinclinicalpracticeto

establishthecauseofsecondaryamenorrhea.Numerousscientificreports

andtreatmentalgorithmsusethisschemeanditisthereforeadvisablefor

physicianswhoareinvolvedinthecareofinfertilitypatientstobefamiliar

withtheWHOclassification.