Description of Amenorrhea
Amenorrhea is absence of menses in women. It can be primary (if menses have never occurred) or secondary (if menses do not occur for 3 to 6 months in a woman who was earlier menstruating).
Causes and Risk Factors
If a girl reaches 16 years of age and has not begun her periods, it is called primary amenorrhea. It can be caused by a deficiency in sex hormones due to:
1. Chromosomal disorders such as Turner syndrome
2. Structural abnormalities of the reproductive organs such as uterus, cervix, and vagina
3. Problems with the pituitary gland that makes hormones, such as a tumor
If a woman who was having periods earlier misses them three times in a row, it is called secondary amenorrhea. It can be due to:
4. Polycystic ovary syndrome (PCOS)
Other causes of amenorrhea may include:
1. Too much exercise
2. Malnutrition and eating disorders such as anorexia nervosa
4. Surgical removal of ovaries
5. Medications such as those for depression, blood pressure, or use of illicit drugs
6. Use of some contraceptives (IUDs)
8. Obesity, diabetes mellitus, celiac disease, sickle cell disease, inflammatory bowel disease, and cystic fibrosis
Signs and Symptoms
Apart from absence of menses, other symptoms may include:
4. Changes in vision or sense of smell
5. Changes in hair or nails
6. Pain or other problems in the joints, muscles, limbs, etc.
7. Vaginal dryness
8. Hot flushes
9. Inability to sleep
10. Night sweats
The doctor would take complete medical and family history. Investigations that may be performed are:
1. Physical examination to evaluate growth, body mass index (BMI), hair loss and excess facial hair, acne, and sexual maturity (development of breast, pubic, and axillary hair)
2. Blood test for complete blood count (CBC), prolactin, TSH, FSH, and testosterone
3. Urine test for pregnancy [human chorionic gonadotropin (hcg)]
4. Pelvic ultrasound to evaluate structural abnormalities
5. Chromosomal study (karyotyping)
6. Magnetic resonance imaging (MRI) of reproductive organs
The treatment will depend on the cause of amenorrhea.
1. Chemotherapy or surgery may be required if amenorrhea is caused by a tumor.
2. If amenorrhea is caused by a disease such as diabetes, celiac disease, etc. treating the disease would restore normal periods.
3. Hormone replacement therapy may be required in females who have problems with the ovary.
4. Improving weight and nutrition may be recommended in females with eating disorders or malnutrition.
5. Oral contraceptive pills may be given for females with PCOS. Drugs like metformin and spironolactone may also be recommended.
6. Hormone progesterone (medroxyprogesterone) may be given periodically in women who have normal estrogen levels.
Complications and When Should You See a Doctor
Depending on what causes amenorrhea, it may lead to infertility if untreated. Low estrogen levels are also associated with weakening of bones. See a doctor if puberty does not begin by 13 years of age or if it begins, but does not progress further.
Prognosis and Prevention
The prognosis will depend on the cause of amenorrhea.
Amenorrhea due to genetic disorders or birth defects cannot be prevented. Maintaining a healthy lifestyle by having proper nutrition and keeping a healthy weight may help reduce the risk of amenorrhea due to nutritional disorders.
Frequently Asked Questions about Amenorrhea
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