Differential diagnosis of uterine amenorrhea

The cause of uterine amenorrhea is in the uterus. In cases of congenital absence of uterus or uterine hypoplasia, endometrial damage or hysterectomy, there will be no menstruation even if the ovaries are functioning well and sex hormone secretion is normal. The differential diagnosis of uterine amenorrhea is as follows:

Ovarian amenorrhea

Without the development of eggs, there will be no menstruation. This type of amenorrhea is called ovarian amenorrhea. The cause may be congenital ovarian hypoplasia and no eggs, or amenorrhea due to egg exhaustion due to various acquired reasons. The former is primary ovarian amenorrhea, while the latter is secondary ovarian amenorrhea, also known as premature ovarian failure.

Hypothalamic-pituitary amenorrhea

Normal menstruation is controlled by the mutual regulation between the central nervous system, the hypothalamus-anterior pituitary and the ovarian function. Any factor that directly or indirectly affects the hypothalamus-pituitary function, resulting in hypothalamic secretion of gonadotropin-releasing hormone and hypothalamic secretion of gonadotropin, is hypothalamic-pituitary amenorrhea, which includes the following 3 types:

1. Congenital absence of uterus or uterine hypoplasia: It is primary amenorrhea with normal ovarian function. The patient's external genitalia and secondary sexual characteristics are well developed. Cytogenetic examination shows positive sex chromatin and karyotype is 46XX.

2. Endometrial damage or hysterectomy: If the endometrium is damaged by radiation therapy, too deep a curettage or too high aspiration pressure, severe infection, or too long a breastfeeding period, the endometrium may shrink excessively and lead to amenorrhea.

3. Poor endometrial response: The endometrium does not respond to the sex hormones secreted by ovarian hormones, there is no cyclical change, and therefore there is no menstruation.