Abstract
A complete interaction in the hypothalamic-pituitary-ovary-uterus (H-P-O-U) axis must take place in order for normal menstruation occurs. If any of the components in the H-P-O-U axis are nonfunctional, amenorrhea could occur. The prevalence of amenorrhea not due to pregnancy or lactation is approximately 3% to 4% in reproductive women. Because there are many causes of amenorrhea, the clinicians should be concerned with array of potential diseases and disorders involving unfamiliar organ systems, some carrying morbid and even lethal consequences for the patients. To explore the causes of amenorrhea, thorough evaluation of H-P-O-U axis and endocrinologic profiles are needed. The etiologic diagnosis is almost always possible with proceeding step by step approaches.
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