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Amenorrhoea (Amenorrhea),Symptoms-Causes-Types-Treatment-and-Complications

What Is Amenorrhea:
               Amenorrhea is a term used in medicine which means the absence of menstrual vaginal bleeding.

Types Of Amenorrhea:

              Amenorrhea is classified as Primary Amenorrhea and

Secondary Amenorrhea.

Primary Amenorrhea:
              Primary Amenorrhea means menstruation has never been started in a woman even after the age 16.

Causes Of Primary Amenorrhea:
The common cause behind primary amenorrhea is genetic, that is during the development of the baby in the uterus its reproductive organs fail to develop.
for example in Turner's syndrome, female baby lacks an X chromosome and her ovary is replaced by scar tissue which produces very little estrogen.
Moreover, Diseases of hypothalamus and pituitary cause primary amenorrhea. Because these two glands control the function of ovary and uterus. They regulate the hormone production by the ovary. If one of these glands becomes abnormal, it will affect the function of the female reproductive system.
Other causes of amenorrhea include;
Adrenal hyperplasia and poly-cystic ovarian syndrome.
Adrenal hyperplasia disturbs the balance between androgens and estrogens in the female while polycystic ovarian syndrome interferes with both ovulation and hormone production by the ovary.

Secondary Amenorrhea:
            Secondary amenorrhea is a medical term implied for those women who were menstruating previously but now showing the absence of menses for consecutive 3 months.
There are many causes of secondary amenorrhea.

Causes of Secondary Amenorrhea:
                        Pregnancy is the normal physiological cause of amenorrhea. The other causes of amenorrhea include diseases of pituitary, hypothalamus, ovary or uterus.

Hypothalamic (secondary ) amenorrhea and its causes:

                       Hypothalamic amenorrhea results from various defects in the hypothalamus. the hypothalamus secretes hormones which stimulate the pituitary gland. and hormones of the pituitary gland, in turn, control the function of the ovary. any disturbance in hypothalamic hormone production will ultimately lead to ovarian problems and amenorrhea.
the causes of hypothalamic amenorrhea include;
severe illness, extreme vigorous exercise, extreme weight loss, physical or emotional stress.

Pituitary Amenorrhea and causes:
                      In pituitary amenorrhea, hypothalamus secretions are normal but the problem lies in the pituitary gland. Pituitary gland doesn't secrete gonadotrophins ( pituitary hormones which regulate the functions of gonads that is ovaries in females and testes in males) and this problem affects the function of the female reproductive system and amenorrhea may result.
causes include:

  • pituitary tumors,
  • Hypersecretion of prolactin by the pituitary. Prolactin enhances milk production but it causes amenorrhea.
  • postpartum pituitary necrosis
  • autoimmune hypophysitis (autoimmune destruction of pituitary cells )
Ovarian amenorrhea, Causes:
                   This type of amenorrhea occurs because of the problems in the ovary. 
causes include:
  • Polycystic ovarian syndrome
  • gonadal dysgenesis (abnormal development of ovary)
  • Ovarian failure ( early menopause )
  • autoimmune oophoritis (destruction of the ovary by its own cells)
  • Anovulation
Uterine amenorrhea Causes:
amenorrhea due to the uterine cause is seen in Asherman's syndrome. It results from scarring of the uterine lining after instrumentation of uterine cavity to manage postpartum bleeding, infection or to perform the abortion.

Other Causes:
  • Chronic diseases e.g TB
  • Radiation and Xrays
  • Craniopharyngioma ( a tumor near pituitary)
  • Sarcoidosis
  • nutritional deficiency
  • Kallmann syndrome ( deficiency of Gonadotrophins)
  • Cushing's syndrome
  • Acromegaly
  • Hypothyroidism
  • Hyperandrogenemia (high levels of male hormones in the blood)
  • Galactosemia (a genetic disorder in which galactose accumulates in the blood)
  • Aplasia of vagina, cervix, uterus or ovary
  • imperforate hymen
  • Depression or psychiatric disorder
  • Neuroleptics
Symptoms Of Amenorrhea:

  • Galactorrhea (oozing of milk from nipples of a nonpregnant woman.
  • Headache associated with a blurring of vision
  • hirsutism ( increased hair growth )
  • anxiety
  • Excessive weight gain or weight loss
  • vaginal dryness

  • Blood tests to find out the levels of FSH, LH, TSH, Estrogens, Androgens and prolactin.
  • Ultrasonography to detect pelvic and ovarian problems for example poly cystic ovarian syndrome.
  • Thyroid function test
  • CT scan or MRI of brain to detect pituitary or hypothalamus problems
  • Hysterosalpingogram or saline infusion songraphy are done to examine the uterus
  • Hysteroscopy
Treatment of Amenorrhea:

                        Correct Treatment is  done only if correct cause is known. The goal of the treatment is to treat the cause.
  • Surgeries may be recommended to treat the anatomical abnormalities.
  • Behavioral change is advised if patient is doing vigorous exercise or loosing weight or suffering from anxiety or stress.
  • Hormone Therapy in premature Ovary failure and hormonal imbalance.
  • Polycystic ovarian syndrome is treated by various drugs that reduce the activity of male hormones.
  • Drugs that reduce prolactin levels for example bromocriptine.
  • Drugs that induce ovulation for example clomiphene.
  • Herbal treatment
  • Thyroid hormones in patients with hypothyroidism.
Complications Of Amenorrhea
complications of amenorrhea depends upon underlying cause.
Infertility is a common complication of amenorrhea other common complication is osteopenia and osteoporosis.


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