AMENORRHEA: PrimaryAmenorrhea 46, XX Gonadal Dysgenesis (e.g. Fragile X, Balanced Translocations, Turner's mosaic) 46, XY Gonadal Dysgenesis (e.g. Swyer's Syndrome) 45, XO Turner syndrome Savage syndrome (ovarian resistance) Premature Ovarian Failure (Autoimmune, Iatrogenic) Secondary Absence of menses for 3 cycles or 6 months Primary No onset of menarche by age 16 with secondary sexual characteristicsOr, No onset of menarche by age 14 without secondary sexual characteristics Ovarian Etiology High FSH Low Estrogen Receptor Abnormalities and Enzyme DeficienciesCentralLow FSHLow Estrogen Congenital Outflow Tract Anomalies Imperforate hymen Transverse vaginal septum Vaginal agenesis (Mayer-Rokitansky-Koster-Hauser syndrome) Cervical stenosis Surgery Irradiation Tumor, Infiltration Hyperprolactinemia Hypothyroidism Androgen insensitivity 5-? Reductase deficiency 17- ? Hydroxylase deficiency Vanishing Testes Syndrome Absent Testes Determining Factor Hypothalamic Pituitary Functional (e.g. eating disorder, weight loss, stress, excessive exercise, illness) Congenital GnRH deficiency (Kallmann syndrome) Constitutional delay of puberty. Potentially acutely life-threatening presentation

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