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emedicine Amenorrhea Overview

Amenorrhea is the absence of menstrual bleeding and may be primary or secondary.

Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years. Secondary amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for three or more months in the absence of pregnancy, lactation (the ability to breastfeed), cycle suppression with systemic hormonal contraceptive (birth control) pills, or menopause.

or a woman to have regular menstrual cycles, her hypothalamus, pituitary gland, ovaries, and uterus should all be functioning normally. !he hypothalamus stimulates the pituitary gland to release follicle"stimulating hormone ( #$) and luteini%ing hormone (&$). #$ and &$ cause the ovaries to produce the hormones estrogen and progesterone. 'strogen and progesterone are responsible for the cyclical changes in the endometrium (uterine lining), including menstruation. (n addition, a woman)s genital tract should be free of any abnormalities to allow the passage of menstrual blood.

Amenorrhea Causes
Amenorrhea can result because of an abnormality in the hypothalamic"pituitary"ovarian axis, anatomical abnormalities of the genital tract, or functional causes. Hypothalamic causes

*raniopharyngioma (a brain tumor near the pituitary gland) !eratoma (a tumor made up of a mixture of tissues) #arcoidosis (a chronic disease of un+nown cause characteri%ed by the formation of nodules in different parts of the body) ,allmann syndrome (deficiency of gonadotropins, which are hormones capable of promoting growth and function of reproductive organs) -utritional deficiency &ow body weight or growth delay

Pituitary causes

.rolactinemia (high blood levels of prolactin, a hormone that stimulates secretion of mil+ from the breasts during breastfeeding) " possibly caused by prolactinoma (a tumor of the pituitary gland secreting the hormone prolactin) /ther pituitary tumors (for example, *ushing syndrome, acromegaly, or thyroid" stimulating hormone)

.ostpartum pituitary necrosis (death of pituitary cells after a woman delivers a baby) Autoimmune hypophysitis (cells of the pituitary gland destroyed by the body)s own defense system) .ituitary radiation #arcoidosis

Ovarian causes

Anovulation (lac+ of the release of an egg) $yperandrogenemia (high blood levels of male hormones) .olycystic ovary syndrome (hormonal disorder affecting women of reproductive age) .remature ovarian failure !urner syndrome (a genetic disorder characteri%ed by underdeveloped ovaries, absence of menstrual onset, and short stature) .ure gonadal dysgenesis (defective development of the ovary) Autoimmune oophoritis (cells of the ovaries destroyed by the body)s own defense system) ragile 0 premutation 1adiation or chemotherapy 2alactosemia (an inherited disorder in which galactose, a type of sugar, accumulates in the blood) Anatomical abnormalities of the genital tract (ntrauterine adhesions (the opposing surfaces of the uterine cavity stic+ together) (mperforate hymen (a hymen in which there is no opening, the membrane completely closes off the vagina) !ransverse vaginal septum (a dividing wall or membrane in the vagina) Aplasia (absence of an organ or tissue) of the vagina, the cervix, or the uterus

Functional causes

Anorexia3bulimia *hronic diseases (for example, tuberculosis) 'xcessive weight gain or weight loss 4alnutrition 5epression or other psychiatric disorders

1ecreational drug abuse .sychotropic drug use (drugs prescribed to stabili%e or improve mood, mental status, or behavior) 'xcessive stress 'xcessive exercise *ycle suppression with systemic hormonal contraceptive (birth control) pills

Amenorrhea Symptoms
Amenorrhea is a symptom of an underlying disorder rather than a condition in and of itself. Additional symptoms may be present depending on the associated condition.

2alactorrhea (breasts produce mil+ in a woman who is not pregnant or breastfeeding), headache, or reduced peripheral vision could be a sign of an intracranial tumor. (ncreased hair growth in a male pattern (hirsutism) may be caused by excess androgen (a hormone that encourages development of male sex characteristics). 6aginal dryness, hot flashes, night sweats, or disordered sleep may be a sign of ovarian insufficiency or premature ovarian failure. -oticeable weight gain or weight loss may be present. 'xcessive anxiety may be present in women with associated psychiatric abnormalities.

When to Seek Medical Care


*onsult a health care professional if a girl is 14 years old and her secondary sexual characteristics (for example, breast development and pubic hair) have not started to develop, or a girl is 16 years old and has not had her first menstrual period. or women who have already begun menstruating, they should see a health care professional if they have missed three consecutive menstrual periods.

Amenorrhea Diagnosis
A doctor may perform the following tests to determine the cause of the amenorrhea7

8lood tests may be performed to determine the levels of hormones secreted by the pituitary gland ( #$, &$, !#$, and prolactin) and the ovaries (estrogen). 9ltrasonography of the pelvis may be performed to assess the abnormalities of the genital tract or to loo+ for polycystic ovaries. *! scan or 41( of the head may be performed to exclude pituitary and hypothalamic causes of amenorrhea.

(f the above tests are inconclusive, additional tests may be performed including7

!hyroid function tests 5etermination of prolactin levels $ysterosalpingogram (0"ray test) or saline infusion sonography (#(#), both of which examine the uterus $ysteroscopy (visual inspection of the uterine cavity)

Amenorrhea reatment Amenorrhea Sel!"Care at Home


(n some women, nutritional deficiencies induced by dieting can cause amenorrhea. #uch women should eat a properly balanced diet. (n some women, excessive body weight could be the cause of amenorrhea. !hese women should restrict the amount of fat in their diet, and they should exercise moderately to maintain an ideal body weight. 4ore than : hours of vigorous exercise a wee+ may cause amenorrhea. A moderate exercise program may restore normal menstruation. (n women with anorexia nervosa or excessive weight loss, normal menstrual cycles can often be restored by undergoing treatment to restore and maintain a healthy body weight. (f amenorrhea is caused by emotional stress, finding ways to deal with stress and conflicts may help. 4aintaining a healthy lifestyle by avoiding alcohol consumption and cigarette smo+ing is also helpful.