Amenorrhea is the lack of menstruation and may be primary or secondary.
1. Primary amenorrhea is the absence of menstruation and secondary sexual characteristics (eg, breast development and pubic hair in a 14-year-old girl) or absence of menstruation with normal development of secondary sexual characteristics in a 16-year-old girl. age.
2. Secondary amenorrhea occurs in a woman who in the past had menstruation, but then for at least three months without pregnancy , lactation (the ability to breastfeed in the breast), menopause or taking the contraceptive pill .

Amenorrhea should not be confused with the term dysmenorrhea, which indicates periodic period pain.

 

Causes of amenorrhea

Amenorrhea can occur for a variety of reasons. Some are part of a woman’s normal course of life, while others may be the side effects of medications or a sign of a disease.

Natural amenorrhea

During the normal course of life, a woman may have amenorrhea for natural reasons, such as:
1. Pregnancy
2. Breastfeeding
3. Menopause.

Medicines

Certain medications and therapies can cause the absence of menstruation, including certain types of:
1. Antipsychotics
2. Chemotherapy for cancer
3. Anti-depressants
4. Medications for blood pressure
5. Radiation therapy.

The tenderness and addictions

1. Anorexia / bulimia
2. Excess weight loss
3. Metabolic disorders such as obesity
4. Malnutrition
5. Drug addiction
6. Use of psychotropic drugs (medicines prescribed to stabilize or improve mood, mood or behavior)
7. Stress
8. Excessive physical exercise.

 

Diseases that cause amenorrhea

1. Chronic diseases (eg tuberculosis )
2. Depression or other psychiatric disorders.

 

Hormonal imbalance

Many diseases can cause a hormonal imbalance, including:

Polycystic Ovarian Syndrome
The syndrome , polycystic ovary causes relatively high levels of hormones, instead of the normal fluctuation levels seen in the menstrual cycle .

Thyroid malfunction
An overactive thyroid ( hyperthyroidism ) or reduced activity ( hypothyroidism ) can cause menstrual irregularities , including amenorrhea.

Hypothyroidism
Clinical manifestations of thyroid disease are usually noted before amenorrhea.
Mild hypothyroidism is often associated with hypermenorrhea or oligomenorrhea (ie, the menstrual cycle is irregular and lasts for more than 32 days) compared to amenorrhea.
Treatment for hypothyroidism should restore menstruation, but it can take several months to see the results.

Hyperprolactinemia
A patient with high levels of prolactin, galactorrhea, headache or visual disturbances should perform imaging ( magnetic resonance imaging or computed tomography) to rule out a pituitary tumor.
Adenomas are the most common cause of dysfunction of the anterior pituitary gland.

Hypergonadotrophic or primary hypogonadism
This disease is characterized by a reduced or absent production of sex hormones (androgens, estrogens and progesterone).
People suffering from hypergonadotrophic hypogonadism have normal hypothalamic-pituitary activity, but gonadotrophins (FSH, LH and hCG) are elevated due to lack of feedback of sex hormones.
This disease can be caused by:

  • Genetic or autoimmune diseases (such as Turner and Klinefelter syndrome),
  • Infections ,
  • Hepatic or renal diseases,
  • Exposure to radiation,
  • Surgeries.

Hipogonadismo hipogonadotrófico

Hypogonadism is a disorder characterized by reduced or absent production of sex hormones.
In this case, the GnRH, FSH and LH hormones that stimulate the ovaries are missing.

Hypothalamic amenorrhea is caused by abnormalities in the secretion of gonadotropin releasing hormone (GnRH) and the rupture of the hypothalamic-pituitary-ovary system.
This disorder is often caused by excessive weight loss, exercise or stress.
The way stress or weight loss affect gonadotropin secretion is unknown.
Women with excessive weight loss should do therapy for eating disorders such as anorexia nervosa or bulimia nervosa.

Pituitary Tumor
A non-cancerous (benign) tumor in the pituitary gland can interfere with the hormonal regulation of the menstrual cycle.

Postnatal contraceptive pill amenorrhea
Women who stopped taking oral contraceptive pills should menstruate within three months of discontinuing the pill.
Women who are not menstruating after three months from when they stopped taking the pill may suffer from secondary amenorrhea.

Premature
menopause Menopause usually occurs at an age between 45 and 55.
In case of early or premature menopause ovulation and menstruation cease before the age of 40 years.

Lifestyle

Stress
Mental stress can temporarily alter the functioning of the hypothalamus.
The hypothalamus is a region of the brain that controls the hormones linked to the menstrual cycle.

Ovulation and menstrual cycle could stop as a result.
Usually, the regular cycle resumes when stress decreases.

Low Body Weight
An excessively low body weight stops many hormonal functions in the body and can also prevent ovulation.
Often women who have an eating disorder, such as anorexia or bulimia, do not have the cycle due to hormonal changes.

Excessive exercise

Women who train hard because they do sports like gymnastics, ballet or running may have a disruption of the menstrual cycle.
Several factors contribute to the loss of menstruation in athletes, including reduced fat, stress and excessive energy consumption.
Young athletes can develop a combination of diseases called Athlete’s Triad because it includes:

Menstruation may return by eating or less intense athletic training.

Structural problems

Diseases of the sex organs can cause amenorrhea. Some examples:

Uterine scars . Asherman’s syndrome, a disease in which the fibrous tissue accumulates in the inner wall of the uterus.
They can sometimes occur after a cesarean section , curettage or treatment for uterine fibroids.
Uterine scars prevent the accumulation and loss of menstrual blood .

 

Deficiency of reproductive organs
Sometimes problems arise during fetal development and a girl can be born without an important part of the reproductive system, such as the uterus, cervix or vagina.
Because the reproductive system does not develop normally, it will not have the menstrual cycle.

Structural anomaly of the vagina
A vaginal obstruction can prevent visible menstrual bleeding.
A membrane or an abnormal wall in the vagina can block the flow of blood from the uterus and cervix.

 

Symptoms of amenorrhea

In addition to not having menstruation, other symptoms may be:

  • Changes in breast size,
  • Loss of weight or gain,
  • Loss of hay (galactorrea)
  • Increased hair with male characteristics (hirsutism) and acne ,
  • Vaginal dryness,
  • Change in voice.

If amenorrhea is caused by a tumor in the pituitary gland, other tumor-related symptoms such as loss of vision and headache may occur .

 

Diagnosis of amenorrhea

Signs and tests
The gynecologist must perform a physical and pelvic exam to find out if the patient is pregnant.
You need to perform a pregnancy test .
Blood tests to check for hormone levels include:

  • Levels of estradiol,
  • Levels of follicle – stimulating hormone (FSH),
  • Luteinizing hormone (LH),
  • Prolactin level,
  • Serum levels of testosterone,
  • Thyroid hormone (TSH).

Other tests that can be done are:

  • Computed tomography or brain resonance to check for tumors,
  • Biopsy of the uterine mucosa,
  • Genetic testing,
  • Ultrasonography of the pelvis or hysterosonography.

 

What is the treatment for amenorrhea?

Treatment for primary and secondary amenorrhea depends on the exact cause.
Treatment goals include: relief of symptoms caused by:

  • Hormonal imbalance,
  • Restore menstruation,
  • Prevent complications of amenorrhea
  • Achieve  fertility .

In cases where anatomical or genetic abnormalities are the cause of amenorrhea (primary amenorrhea), surgery may be recommended.

The hypothalamic amenorrhea is linked to:

  • Weight loss,
  • Excessive exercise,
  • A disease,
  • Emotional stress.

It can usually be resolved by treating the underlying cause.
For example, weight gain and reduced training intensity can restore menstruation in young athletes who have no other causes of amenorrhea.
In some cases, it may be necessary to consult a nutritionist.

For  premature ovarian failure , hormone therapy may be recommended to avoid the unpleasant symptoms of estrogen reduction and to prevent complications such as osteoporosis.
Treatment for premature ovarian failure may consist of birth control pills for women who do not want to get pregnant or alternatively estrogen and progesterone medications.
Hormone treatment in postmenopausal women may result in health risks in older women, young girls with premature ovarian failure have benefits with this therapy to avoid bone density loss.

Women with polycystic ovary syndrome may improve with a treatment that reduces the level of male hormones or androgens.

Dopaminergic agonist drugs such as bromocriptine (Parlodel) may reduce the high levels of prolactin that are responsible for amenorrhea.
Dosage of medicines taken should be made by your doctor.

Artificial or assisted insemination and administration of gonadotropin-containing medications (stimulate follicle maturation in the ovary) may be useful for women who suffer from certain types of amenorrhea but want to become pregnant .
You should always consult a doctor to evaluate any contraindications or side effects of the medicines.

Many companies and individuals have supported herbal therapies as amenorrhea treatment, but there is no scientific evidence on the effectiveness of these products.

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