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Amenorrhea

Definition


Disease: Amenorrhea Amenorrhea
Category: Gynecological diseases
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Disease Definition:

The absence of menstruation is called amenorrhea, which is when a woman misses one or more menstrual periods. The absence of menstrual periods by the age of 16 is referred to as primary amenorrhea, whereas the absence of menstrual periods after a woman has been previously menstruating is called secondary amenorrhea. Pregnancy is the most likely reason for missing a period if a woman is sexually active and healthy.

There are many possible explanations for amenorrhea. It is a sign, not a disease and seldom results from a serious condition. Even though not knowing why menstruation has stopped can be quite stressful, once the root of the problem is discovered, amenorrhea usually resolves after the underlying condition has been treated.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some other signs and symptoms may be experienced along with the absence of menstrual periods, depending on the cause of this disorder, such as vision changes, headache, milky nipple discharge or excessive hair growth on the face and torso (hirsutism).

If a girl has never had a menstrual period and she’s 16 or older, or if she has previously menstruated, but missed three or more periods in a row, then she should see a doctor.

Causes:

Some other signs and symptoms may be experienced along with the absence of menstrual periods, depending on the cause of this disorder, such as vision changes, headache, milky nipple discharge or excessive hair growth on the face and torso (hirsutism).

If a girl has never had a menstrual period and she’s 16 or older, or if she has previously menstruated, but missed three or more periods in a row, then she should see a doctor.
A secondary amenorrhea is more common than the primary one and some of its possible causes may be:

Pregnancy:
This is the most common cause of amenorrhea in women of reproductive age, because when a fertilized egg is implanted in the lining of the uterus, the lining remains to nourish the fetus and isn't shed as menstruation.

Breast-feeding:
Amenorrhea is often experienced by breast-feeding mothers. Menstruation may not occur, even though ovulation occurs and it may result in pregnancy despite the absence of menstruation.

Contraceptives:
When birth control pills are stopped, it may take three to six months to resume normal ovulation and menstruation. Implanted or injected contraceptives may also cause amenorrhea, as well as progesterone-containing intrauterine devices.

Medication:
Some medications, such as antipsychotics, antidepressants, oral corticosteroids and some chemotherapy drugs can cause menstrual periods to stop, resulting in amenorrhea.

Stress:
The function of the hypothalamus, which is an area in the brain that controls the hormones that regulate the menstrual cycle, can be temporarily altered because of mental stress, causing ovulation and menstruation to stop. After the stress decreases, regular menstrual periods usually resume.

Low body weight:
Women who have an eating disorder, such as bulimia or anorexia, usually stop having periods due to abnormal hormonal changes, because excessively low body weight interrupts many hormonal functions in the body, possibly stopping ovulation.

Excessive exercise:
Several factors are combined to contribute to the loss of periods in athletes, including stress, low body fat and high energy expenditure. Because of these reasons, women who participate in sports that require rigorous training, such as long-distance running, gymnastics or ballet, may find their menstrual cycle interrupted.

Uterine scarring:
After uterine procedures, such as a dilation and curettage (D and C), treatment for uterine fibroids or cesarean section, Asherman's syndrome may occur, a condition in which scar tissue builds up in the lining of the uterus. Uterine scarring inhibits the normal buildup and shedding of the uterine lining, which often results in the absence of periods or only light menstrual bleeding.

Thyroid malfunction:
Amenorrhea, as well as other menstrual irregularities could be caused by hypothyroidism. Thyroid disorders could also cause an increase or decrease in the production of prolactin, a reproductive hormone generated by the pituitary gland that can affect the hypothalamus and disrupt the menstrual cycle.

Pituitary tumor:
A benign tumor in the pituitary gland, such as adenoma or prolactinoma, can cause a prolactin overproduction, a condition that can interfere with the regulation of menstruation. This type of tumor can be treated with medication and it requires surgery only in some rare cases.

Hormonal imbalance:
One of the common causes of amenorrhea is PCOS (polycystic ovary syndrome). In this condition, the pituitary hormones that lead to ovulation and menstruation are decreased because of relatively high and sustained levels of estrogen and androgen, a male hormone, instead of the fluctuating levels seen in the normal menstrual cycle. This disorder (PCOS) is associated with acne, obesity, amenorrhea, excess facial hair or an abnormal and often heavy uterine bleeding.

Primary ovarian insufficiency:
This disorder is also known as premature menopause and it may result from genetic factors or autoimmune disease, but often no cause is found. Although menopause usually occurs between the ages 45 and 55, in some women the ovarian supply of eggs diminishes before the age of 40, a condition known as primary ovarian insufficiency. In this condition, the amount of circulating estrogen in the body is decreased, making the endometrium (uterine lining) thinner and causing the menstrual periods to stop.

Some of the common causes of primary amenorrhea are:

Problems with the hypothalamus:
Functional hypothalamic amenorrhea is a disorder of the hypothalamus, which is an area at the base of the brain that acts as a control center for the body and regulates the menstrual cycle.

Chromosomal abnormalities:
A premature depletion of the eggs and follicles involved in ovulation and menstruation can be caused by certain chromosomal abnormalities.

Structural abnormality of the vagina:
A membrane or wall could exist in the vagina, blocking the outflow of blood from the uterus and cervix. This obstruction can prevent visible menstrual bleeding.

Pituitary disease:
A tumor or another invasive growth may disrupt the pituitary gland's ability to perform its function, since it is one of the glands in the brain that's involved in regulating the menstrual cycle.

Physical or psychological stress or eating disorders:
Some examples for these conditions are excessive exercise, bulimia or anorexia, which can contribute to a disruption in the normal function of the hypothalamus. In some rare cases, a tumor could prevent the hypothalamus from functioning normally.

Lack of reproductive organs:
Some developmental problems could end up in the birth of a baby girl without some major part of her reproductive system, such as her vagina, cervix or uterus. She will not have menstrual cycles because her reproductive system didn't develop normally.

Complications

Complications:

None

Treatments:

A woman may be suggested making lifestyle changes depending on her weight, physical activity or stress level, because treatment is based on what's causing amenorrhea. In order to treat PCOS or hypothalamic amenorrhea, oral contraceptives may be prescribed. Additionally, medications could treat amenorrhea that is caused by thyroid or pituitary disorders.

Prognosis:

Not Available

Expert's opinion

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