Epidemiology and etiology

O Unrecognized pregnancy remains the most common cause of amenorrhea, and a urine pregnancy test should be one of the first steps in the evaluation of this disorder. To help organize an approach to diagnosis and treatment, it is helpful to consider the organs involved in the menstrual cycle, which include the uterus, ovaries, anterior pituitary, and hypothalamus. After pregnancy, the five most common causes of secondary amenorrhea, in descending order of prevalence, include :

• Hypothalamic suppression (33%)

• Hyperprolactinemia (14%)

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