The first descriptions about disturbances in menstrual cycle are found in Papyrus Ebres [named after the Egyptologist Georg M. Ebers (1837-1898)], from New Kingdom period (1450-1550 B.C.).<unk>  may be classified according to etiology into three subtypes, including primary<unk> , secondary<unk> , and functional<unk> . Primary<unk>  is basically refers to a young girl who have not experienced menarche, at all. Secondary<unk>  reflects a woman who had ordinary menstruation cycles, experiencing at least 3 months of absence of menstruation cycle. Functional<unk>  is a subtype of the<unk>  caused by exaggerated different lifestyles. Primary and secondary<unk>  are distinguished solely based on history. Mainly the pathophysiology of<unk>  is described in many categories, include hypothalamic, pituitary, thyroid, adrenal, ovarian, uterine, and vaginal pathogenesis. About 25 various genes, in 3 different group of Kallmann syndrome related genes, hypothalamus-pituitary-gonadal (HPG) axis related genes, and obesity related genes, play role in<unk> . Common causes of<unk>  include breastfeeding, pregnancy, menopause, and stress. Primary<unk>  must be differentiated from other diseases that cause lack of menstrual cycle, such as Mullerian agenesis, 3-beta-hydroxysteroid dehydrogenase type 2 deficiency, androgen insensitivity syndrome, Kallmann syndrome, Turner syndrome, and 17-alpha-hydroxylase deficiency. In contrast, secondary<unk>  must be differentiated from other diseases that cause menstrual cycle arrest, such as primary ovarian insufficiency, hypothyroidism, hyperprolactinemia, polycystic ovary syndrome, and Asherman's syndrome. The prevalence of<unk>  is approximately 3,000 to 4,000 per 100,000 individuals worldwide. The most common risk factor in the development of primary<unk>  is chromosomal disorder and the most common risk factor in the development of secondary<unk>  is breastfeeding. If left untreated, all of patients with<unk>  may progress to develop infertility and osteoporosis. Common complications of<unk>  are based on the background disease that induced it. Prognosis is generally excellent and the mortality rate of patients with<unk>  is approximately less than 1%, generally in<unk>  due to brain lesions. The initial laboratory tests for evaluating<unk>  are pregnancy test, thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), and prolactin (PRL). Second line laboratory tests include free and total testosterone, dehydroepiandrosterone sulfate (DHEAS), and also progesterone challenge test. There are no echocardiography findings associated with<unk> . However, an echocardiography may be helpful in the diagnosis of the diseases that can cause<unk> , such as Turner syndrome. Findings on an echocardiography suggestive of Turner syndrome include bicuspid aortic valve, elongation of transverse aortic arch, coarctation of aorta, and partial anomalous pulmonary venous return (PAPVR). There are no ultrasound findings associated with<unk> . However, an ultrasound may be helpful in the diagnosis of the diseases that can cause<unk> , such as polycystic ovary syndrome (PCOS), premature ovarian insufficiency, androgen insensitivity syndrome, 17-alpha hydroxylase deficiency, and also anatomic genital defects. Pharmacologic medical therapy is recommended among patients with hypothalamic causes, pituitary causes, ovarian insufficiency, and chronic anovulation. The general principle of the treatment in<unk>  is sex hormone replacement therapy, with suitable forms of estrogen and progesterone. The mainstay of treatment for<unk>  is medical therapy. Surgery is usually reserved for patients with either hypothalamus or pituitary tumors, Turner syndrome, and genital anatomical defects (imperforate hymen or transverse vaginal septum). The surgical treatment for hypothalamus or pituitary tumors is tumor resection via endoscopic transsphenoidal surgery. Ovaries have to be excised in Turner syndrome to prevent malignant transformation. Small incision is the main surgery for imperforate hymen and septal excision is the main treatment for transverse vaginal septum.
Amenorrhea
Logorrhoea
Dysmenorrhea
Constipation
Constipation  
Dysuria
Steatorrhea
Dyspareunia