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AMENORRHEA

Amenorrhea is the absence of one or more missed menstrual periods. Women within the reproductive period who are neither pregnant nor menopausal but have missed at least three menstrual periods in a row have amenorrhea, as do girls who haven't begun menstruation by age 15. The most common cause of amenorrhea is pregnancy. Other causes of amenorrhea include problems with the reproductive organs or with the glands that help regulate hormone levels. Treatment of the underlying condition often resolves amenorrhea

Amenorrhea is not about having irregular periods. The presence of amenorrhea means, one never gets their period. Even though it is not a disease, the doctor needs to know about it because it might be a symptom of a medical condition that can be treated.

TYPES OF AMENORRHEA

There are two types of amenorrhea:

  • Primary amenorrhea - When a young woman has not had her first period by the age of 16.
  • Secondary amenorrhea - This is when a woman who has had normal menstrual cycles stops getting her monthly period for 3 or more months.

CAUSES

Amenorrhea can occur for a variety of reasons. In the course of a woman's life, some cases of amenorrhea are normal. Others however, may be a side effect of medication or the sign of a medical problem.

Medications

Certain medications can also cause amenorrhea, including some types of:

  • Blood pressure medications
  • Antidepressants
  • Antipsychotics
  • Allergy medications
  • Cancer chemotherapy

Natural Amenorrhea

A woman may experience amenorrhea for natural reasons, such as:

  • Menopause
  • Pregnancy
  • Contraceptives
  • Breast-feeding

Some women who use birth control tablets may not have monthly periods. In some cases, it may take some time before regular ovulation and menstruation return even after stopping oral contraceptives.

Lifestyle Factors

Some lifestyle factors can also cause amenorrhea, examples may be:

  • Excessive exercise - Activities that require rigorous training, may cause interruptions in menstrual cycles even though there are several other factors that combine to contribute to the loss of periods in athletes. This would include low body fat, stress and high energy expenditure.
  • Low body weight - Excessively low body weight interrupts many hormonal functions in the body which potentially halts ovulation. Some women have eating disorders, anorexia or bulimia often stops menstrual periods because of these abnormal hormonal changes.
  • Stress - Mental stress can temporarily alter the functioning of an area of the brain that controls the hormones that regulate menstrual cycle (hypothalamus). Ovulation and menstruation may stop consequently. Regular menstrual periods will resume after the stress decreases.

Structural problems

Problems with the sexual organs can also cause amenorrhea. Examples include:

  • Uterine scarring Also called Asherman's syndrome, this is a condition in which scar tissue builds up in the lining of the uterus. It can occur after cesarean section or treatment for uterine fibroids or even a dilation and curettage (D&C). Uterine scarring prevents the normal buildup and shedding of the uterine lining.
  • Lack of reproductive organs - Sometimes a woman can not have menstrual cycles because her reproductive system did not develop normally. Problems may arise during fetal development leading to girls being born without some major part of the reproductive system (e.g. uterus, cervix or even vagina).
  • Structural abnormality of the vagina - An obstruction of the vagina may prevent visible amenorrhea. The presence of a membrane in the vagina may block the outflow of blood from the uterus and cervix.

Hormonal Imbalance

Some medical problems can cause hormonal imbalances, these may include:

  • Polycystic ovary syndrome (PCOS) Instead of the fluctuating levels seen in normal menstrual cycles, PCOS causes relatively high and sustained levels of hormones.
  • Pituitary tumor - A noncancerous (benign) tumor in the pituitary gland can interfere with the regulation of menstruation hormones.
  • Thyroid malfunction Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) gland can cause menstrual irregularities, including amenorrhea.
  • Premature menopause Even though menopause usually begins around age 50, the ovarian supply of eggs diminishes before age 40 in some women, and menstruation ceases as a consequence.

SYMPTOMS

The main symptom of amenorrhea would be the absence of menstrual periods. However, depending on the cause, one might experience other signs or symptoms such as:

  • Headaches
  • Vision changes
  • Pimples/ acne
  • Hair in unwanted areas or hair loss
  • Pelvic pain
  • Breast swelling and milk secretions
  • Nausea
  • Enlarged thyroid
  • Changes in Skin
  • Weight gain
  • Lowering of voice
  • Altered sex drive
  • Hormonal imbalance

WHEN TO SEE A DOCTOR

One must consult our doctors if she has missed at least three consecutive menstrual periods, or if at age 15 or older she has never had a menstrual period.

RISK FACTORS

The under listed factors may increase the risk of amenorrhea:

Family history - One may have inherited a predisposition for the problem.  Especially if other women in the family have experienced amenorrhea before.

Eating disorders - Women with eating disorders, like anorexia or bulimia are at higher risk of developing amenorrhea.

Athletic training - Rigorous athletic training can increase one's risk of amenorrhea.

DIAGNOSIS

To diagnose amenorrhea, the doctor will perform a pelvic exam to check for any problems with the reproductive organs. If the patient has never had a period, the doctor may examine the breasts and genitals to see if she is experiencing the normal changes of puberty.

Finding the underlying cause of Amenorrhea could be time consuming and may require more than one kind of testing because the condition could be a sign of a complex set of problems that could even be hormonal.

Lab tests

A variety of blood tests in the laboratory may be necessary, including:

Pregnancy test - Most probably the first test any doctor would suggest, in order to rule out or confirm a possible pregnancy.

Thyroid function test - The amount of thyroid-stimulating hormone (TSH) in the blood if known, can be used to determine if the thyroid gland is working properly.

Ovary function test This test aims at measuring the amount of follicle-stimulating hormone (FSH) in the blood. It can be used to determine if the ovaries are working properly.

Prolactin test To determine if levels of the hormone prolactin in the blood is low, which may be a sign of a pituitary gland tumor.

Male hormone test The doctor may wish to check the level of male hormones in the blood, especially in the patient is experiencing increased facial hair and a lowered voice.

OTHER TESTS

Hormone challenge test

For this test, the patient will be asked to take a hormonal medication for seven to 10 days to trigger menstrual bleeding. The results from this test can tell the doctor whether the monthly periods have stopped due to a lack of estrogen.

Imaging tests

The doctor might recommend one or more imaging tests depending on the symptoms and the result of any blood tests, possibly may include

Ultrasound The use of sound waves to produce images of internal organs. If the patient has never had a period, the doctor may suggest an ultrasound test to check for any abnormalities in the reproductive organs.

Computerized tomography (CT) A combination of many X-ray images taken from different directions to create cross-sectional views of internal structures. This scan can indicate whether your uterus, ovaries and kidneys look normal or otherwise.

Magnetic resonance imaging (MRI) - MRI involves the use of radio waves with a strong magnetic field to produce highly detailed images of soft tissues within the body.  

Scope tests

Used if other testing fails or reveals no specific cause. The doctor may recommend a hysteroscopy for instance. Scope tests are those in which a thin, lighted camera is passed through the vagina and cervix to look at the inside of the uterus.

TREATMENT

The course and types of treatment will depend on the underlying cause of the amenorrhea. Contraceptive pills or other hormone therapies can restart menstrual cycles in some cases. If caused by thyroid or pituitary disorders, amenorrhea may be treated with medications. Whilst resorting to surgery may be necessary if a tumor or structural blockage is the cause.

Lifestyle factors like too much exercise or too little food can cause amenorrhea, and so patients need to strive for balance in work, recreation and rest.

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