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Amenorrhea

Overview

Amenorrhea is the medical term for when a woman doesn’t have menstrual periods. It is when you aren’t getting your periods even though you’ve been through puberty, aren’t pregnant, and haven’t gone through menopause.

Etiology

The main causes of primary amenorrhea include family history, genetics, and lifestyle, whereas pregnancy, breastfeeding, and menopause are the main causes of secondary amenorrhea. Other possible causes include:

  • Pills, injections, and intrauterine devices are some of the examples of birth control methods that can have an impact on your menstrual cycle.
  • Use of antidepressants and blood pressure medications.
  • Exposure to Chemotherapy and radiation therapy
  • Having Polycystic ovary syndrome (PCOS).
  • Having Fragile X syndrome or fragile X-associated primary ovarian insufficiency
  • Issues with pituitary and  thyroid gland
  • Hypothalamic disorder
  • Scar tissue in the uterus

Types

Amenorrhea is divided into two categories.

 Primary Amenorrhea When a young woman reaches the age of 15 and has not had her first period.

 Secondary Amenorrhea occurs when you have had regular menstrual periods, but then they stop for three or more months.

Signs and Symptoms

The main symptom of amenorrhea is the absence of your monthly period. It often signifies a more significant health problem or condition. Related symptoms can include:

  • Headache.
  • Vision changes.
  • Acne.
  • Nausea.
  • Extra facial hair.
  • Hair loss.
  • Changes in breast size.
  • Milky fluid, or discharge, from breasts.

Risk Factors

Women with the following factors are more at risk:

  • Amenorrhea or early menopause in family history
  • A chromosomal or genetic defect. These can have an impact on ovarian function and the menstrual cycle. For example, Turner’s syndrome
  • Being significantly overweight or underweight 
  • Suffering from an eating disorder
  • A strenuous exercise routine
  • A poor diet
  • Stress

Diagnosis

Your doctor will begin by reviewing your medical history and performing a physical and pelvic examination. They may request a pregnancy test if you're sexually active to rule out pregnancy as a cause.

Finding out what's causing your amenorrhea may require a variety of tests. One or more of the following diagnostic tests may be ordered by your doctor:

  • Blood Tests:

These tests measure the amounts of hormones in your blood like follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), prolactin, and male hormones.

  • Imaging Tests:

They include Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). These tests can reveal abnormalities in your reproductive organs or locate tumors if present. 

  • Hormone Challenge Test:

Your doctor will prescribe a hormonal drug that, when stopped, should result in menstrual bleeding. If you don't, a lack of estrogen may cause amenorrhea.

  • Hysteroscopy:

To examine the inside of your uterus, your doctor will insert a small illuminated camera into your vagina and cervix.

  • Genetic Screening:

It looks for gene mutations that could cause your ovaries to stop operating, as well as detecting missing or partially missing X chromosomes (Turner's syndrome).

  • Chromosome Tests (Karyotype):

Identifies missing, extra, or mutated cells in your chromosomes to help diagnose amenorrhea-causing factors.

Differential Diagnosis

Amenorrhea has various differential diagnoses, including genetic abnormalities, endocrine problems, psychological, environmental, and structural anomalies. Obtaining a complete history and performing a thorough physical examination is necessary for a timely and accurate diagnostic workup.

Complications

The causes of amenorrhea can cause other problems as well. These include:

  • Infertility and pregnancy complications: You can't get pregnant if you don't ovulate or have no menstrual periods. When a hormone imbalance is the cause of amenorrhea, this can also cause miscarriage or other problems with pregnancy.
  • Psychological stress: Not having periods when your peers have theirs can be stressful, especially for young people transitioning into adulthood.
  • Osteoporosis and cardiovascular disease: A lack of hormone estrogen can bring on these two issues. Osteoporosis is a condition in which the bones become brittle. Heart attacks and problems with the blood vessels and heart muscle are all examples of cardiovascular disease.
  • Pelvic pain: An anatomical problem causing amenorrhea may also cause pain in the pelvic area.

Treatment

The treatment options for Amenorrhea differ depending on the cause. You may need to make lifestyle modifications, such as nutrition, exercise, and stress management. Hormonal medications and birth control pills might help you get your period started.  Hormone therapy may be used to bring your hormones back into balance.

Surgery is uncommon. However, it may be required in some instances, such as:

  • To correct chromosomal or genetic abnormalities.
  • Removal of pituitary tumor.
  • Removal of scar tissue from the uterus.

Prevention

Maintain a balanced diet and healthy workout routine. Consult your doctor if you are underweight or overweight and achieve a healthy balance. Keep track of your periods each month once you start menstruating. This can help in the early detection of amenorrhea and the diagnosis and treatment of the condition. It's also a good idea to do it if you want to get pregnant in the future.

Medication

Some causes of amenorrhea can be managed by medical (drug) therapy. Examples include the following:

  • Dopamine agonists, such as bromocriptine or pergolide, effectively treat hyperprolactinemia. Treatment with dopamine agonists medications restores normal ovarian endocrine function and ovulation in most women.
  • Hormone replacement therapy consisting of estrogen and progestin can be used for women in whom estrogen deficiency remains because the ovarian function cannot be restored.
  • Metformin (Glucophage) is a drug that has been successfully used in women with polycystic ovary syndrome to induce ovulation.
  • In some cases, oral contraceptives may be prescribed to restore the menstrual cycle and provide estrogen replacement to women with amenorrhea who do not wish to become pregnant. Before administering oral contraceptives, withdrawal bleeding is induced with an injection of progesterone or oral administration of 5-10 mg of medroxyprogesterone for ten days.

Lifestyle Modification

Amenorrhea can be caused by lifestyle factors such as too much exercise or too little food, so strike a balance between work, recreation, and rest. Assess your life for areas of stress and conflict. If you cannot reduce stress on your own, seek assistance from family, friends, or your physician.

Changes in your menstrual cycle should be noted, and you should consult your doctor if you have any concerns regarding it. Keep track of the dates of your periods. Keep track of when while noting any troublesome symptoms you experience.

Prognosis

Amenorrhea is typically not a life-threatening condition. The prognosis for amenorrhea depends upon the underlying cause and the available type of treatment. For most women, medications, lifestyle changes, or surgery can correct amenorrhea.