What is Amenorrhea: Definition, Causes, Symptoms, Diagnosis and Treatment

It is the absence of menstruation, it can be primary or secondary.

Primary amenorrhea : is the failure of menstruation to occur for one of the following reasons:

  • 16 years or 20 years after the onset of puberty.
  • Approximately in 14 years, girls who have not gone through puberty (for example, accelerated growth, the development of secondary sexual characteristics)

If patients have had menstrual periods of 13 years of age and have no signs of puberty (for example, any type of breast development), they should be evaluated for primary amenorrhea.

Secondary amenorrhea : the cessation of menstruation after it has begun. In general, patients should be evaluated for secondary amenorrhea if menstruation has been absent for 3 months or 3 typical cycles because from menarche to perimenopause, a menstrual cycle that lasts 90 days is unusual.

Amenorrhea is usually classified as:

  • Anovulatorio.
  • Ovulatoria.

Causes

  • Pregnancy (the most common cause in women of reproductive age)
  • Delayed puberty
  • Hypothalamic functional anolation (for example, due to excessive exercise, eating disorders or stress)
  • The use or abuse of drugs (for example, oral contraceptives, antidepressants, antipsychotics)
  • Breast-feeding
  • Polycystic ovary syndrome

Contraceptives can cause the endometrium to be affected, sometimes resulting in amenorrhea; Menstruation usually start again about 3 months after leaving the oral contraceptives.

Antidepressants and antipsychotics can elevate prolactin, which stimulates the breasts to produce milk and can cause amenorrhea.

What are the symptoms of amenorrhea?

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

Galactorrhea (breasts produce milk in a woman who is not pregnant or breastfeeding), headache, or reduced peripheral vision may be a sign of an intracranial tumor.

Increased hair growth in a male pattern ( hirsutism ) can be caused by an excess of androgen (a hormone that stimulates the development of male sexual characteristics).

Vaginal dryness, hot flushes, night sweats, or disordered sleep may be a sign of ovarian failure or premature ovarian failure.

You may notice a noticeable weight gain or weight loss.

Excessive anxiety may be present in women with associated psychiatric abnormalities.

When should I seek medical attention for amenorrhea?

It is always appropriate to seek medical attention for amenorrhea.

Amenorrhea that is not related to pregnancy or menopausal transition (time in which there have been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified) should be further investigated to rule out serious diseases that may cause amenorrhea.

How is amenorrhea diagnosed?

The diagnosis of amenorrhea requires a careful medical history to document the presence of amenorrhea and any other coexisting medical conditions that may be the cause of amenorrhea. A physical examination is also performed, which includes a pelvic exam.

Depending on the results of the history and the physical examination, more diagnostic tests may be ordered. Blood tests may be ordered to examine levels of ovarian, pituitary, and thyroid hormones.

These tests may include measurements of prolactin, follicle-stimulating hormone, estrogen, thyrotropin, dehydroepiandrosterone sulfate (DHEA-S), and testosterone. For some people, a pregnancy test is the first test that is performed.

Imaging studies, such as ultrasound, x-rays, and computed tomography or magnetic resonance imaging may also be recommended in certain people to help establish the cause of amenorrhea.

Treatment

The treatment is directed to the underlying cause; With such treatment, menstruation sometimes resumes. For example, most of the abnormalities that obstruct the genital outlet tract are surgically repaired.

If a “Y” chromosome is present, bilateral oophorectomy is recommended because the risk of ovarian germ cell cancer is increased.

Problems associated with amenorrhea may also require treatment, including

  • The induction of ovulation, if pregnancy is desired.
  • The treatment of symptoms and long-term effects of estrogen deficiency (eg, osteoporosis).
  • Treatment of symptoms and control of the long-term effects of excess estrogen (eg, prolonged bleeding, persistent or marked breast tenderness, the risk of endometrial hyperplasia and cancer).
  • Minimize hirsutism and long-term effects of androgen excess (eg, cardiovascular disorders, hypertension).

The objectives of treatment may be to alleviate the symptoms of hormonal imbalance, establish menstruation, prevent complications and / or achieve fertility, although not all of these objectives can be achieved in all cases.

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

Hypothalamic amenorrhea that is related to weight loss, excessive exercise, physical illness, or emotional stress can usually be corrected by addressing the underlying cause.

For example, weight gain and reduction in exercise intensity can usually restore menstrual periods in women who have developed amenorrhea due to weight loss or excessively intense exercise that have no other causes of amenorrhea.

In some cases, nutritional counseling can be beneficial.

In premature ovarian failure, hormone therapy can be recommended to avoid the unpleasant symptoms of estrogen depletion and to prevent complications of low estrogen, such as osteoporosis.

This may consist of oral contraceptive pills for women who do not want a pregnancy or alternative estrogen and progesterone medications.

While postmenopausal hormone therapy has been associated with certain health risks in older women, younger women with premature ovarian failure may benefit from this therapy to prevent bone loss.

Women with polycystic ovarian syndrome  can benefit from treatments that reduce the level or activity of male hormones, or androgens.

Dopamine agonist medications, such as bromocriptine (Parlodel), can reduce elevated prolactin levels, which may be responsible for amenorrhea. Consequently, medication levels can be adjusted by the person’s physician, if applicable.

Assisted reproduction technologies and the administration of gonadotropin medications (drugs that stimulate follicular maturation in the ovaries) may be appropriate for women with some types of amenorrhea who want to try to become pregnant.

While many companies and individuals have marketed herbal therapies as a treatment for amenorrhea, none of these has been conclusively proven to be beneficial.

These therapies are not regulated by the US FDA. UU And the quality of the herbal preparations has not been proven. Herbal remedies have been associated with serious and even fatal side effects in rare cases, and some preparations have been shown to contain high levels of toxins.

Before deciding to take a natural or alternative remedy for amenorrhea, it is advisable to seek the advice of your health professional.