Amenorrhoea

 

Amenorrhoea

Amenorrhea (uh-men-o-REE-uh) is the absence of menstruation, often defined as missing one or more menstrual periods.

Types of Amenorrhoea?

• Primary amenorrhoea is when girls fail to menstruate by 16 years of age.

• Secondary amenorrhoea is absence of menstruation for more than 6 months in a normal female of reproductive age that is not due to pregnancy, lactation or the menopause.

Who is at risk for amenorrhea?

·        Risk factors for amenorrhea include:

·        Family history of amenorrhea or early menopause.

·        Genetic or chromosomal condition that affects your menstrual cycle.

·        Obesity or being underweight.

·        Eating disorder.

·        Over-exercising.

·        Poor diet.

·        Stress.

·        Chronic illness.

 

Causes of Amenorrhoea?

1.     Hypothalamic disorders

·        Excessive exercise, weight loss and stress.

·        Hypothalamic lesions (craniopharyngioma, glioma), which can compress hypothalamic tissue or block dopamine.

·        Head injuries.

·        Kallman’s syndrome (X-linked recessive condition resulting in deficiency in GnRH causing underdeveloped genitalia).

·        Systemic disorders including sarcoidosis, tuberculosis resulting in an infiltrative process in the hypothalamo-hypophyseal region.

·        Drugs: progestogens, HRT or dopamine antagonists.

 

 

 

2.     Pituitary disorders

• Adenomas, of which prolactinoma is most common.

• Pituitary necrosis (e.g. Sheehan’s syndrome, due to prolonged hypotension following major obstetric

haemorrhage).

• Iatrogenic damage (surgery or radiotherapy).

• Congenital failure of pituitary development.

     3. Ovarian disorders

·        Anovulation is often due to polycystic ovary syndrome (PCOS).

·        Ovarian failure is the cause of hypergonadotrophic hypogonadism.

 

4.     Endometrial disorders

·        Primary amenorrhoea may result from Müllerian defects in the genital tract including an absent uterus, or outflow tract abnormalities, leading to a haematocolpos.

·        Secondary amenorrhoea may result from scarring of the endometrium called Asherman syndrome.

 

What are the symptoms of amenorrhea?

The main symptom is the lack of periods. Other symptoms depend on the cause. You may experience:

·         Hot flashes.

·         Nipples leaking milk.

·         Vaginal dryness.

·         Headaches.

·         Vision changes.

·         Acne.

·         Excess hair growth on your face and body.

 

Investigation of amenorrhoea/oligomenorrhoea?

 

·        Pregnancy test. This will probably be the first test your doctor suggests, to rule out or confirm a possible pregnancy.

·        Hormone assay. LH, FSH and testosterone ( raised LH or raised testosterone could be suggestive of PCOS; raised FSH may be suggestive of POF. A raised prolactin level may indicate a prolactinoma).

·        Thyroid function.

·        An ultrasound scan.

·        Magnetic resonance imaging (MRI).

Karyotyping is diagnostic of Turner’s and other sex chromosome abnormalities.

·        Male hormone test. If you're experiencing increased facial hair and a lowered voice, your doctor may want to check the level of male hormones in your blood.

 

How is amenorrhea treated?

If your period stopped because of menopause or pregnancy, your provider will not need to treat it. In other cases, your treatment will depend on the cause and may include:

·        Losing weight through dieting and exercise (if excess weight is the cause).

·        Gaining weight through an individualized diet plan (if extreme weight loss is the cause).

·        Stress management techniques.

·        Changing exercise levels.

·        Hormonal treatment (medication), as prescribed by your healthcare provider.

·        Surgery (in rare cases).

§  In addition, your healthcare provider may recommend some treatments to help with the side effects of amenorrhea:

·        Estrogen therapy to relieve hot flashes and vaginal dryness.

·        Calcium and vitamin D supplements to keep bones strong.

·        Strength training.

Amenorrhea may be a symptom of anorexia nervosa, an eating disorder. If you or a loved one has this condition, talk to a healthcare provider immediately so you can get the right treatment.

 

 

Lifestyle and home remedies for Amenorrhoea?

·        Some lifestyle factors — such as too much exercise or too little food — can cause amenorrhea, so strive for balance in work, recreation and rest. Assess areas of stress and conflict in your life. If you can't decrease stress on your own, ask for help from family, friends or your doctor.

·        Be aware of changes in your menstrual cycle and check with your doctor if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts and any troublesome symptoms you experience.

 

 

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