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Amenorrhoea is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen during pregnancy and lactation (breastfeeding), the latter also forms the basis of a contraceptive method known as lactation amenorrhea. Outside of the reproductive years there is absence of menses during childhood and after menopause. Amenorrhoea is a symptom with many possible causes. Primary amenorrhea (menstruation cycles never starting) may be caused by developmental problems such as congenital absence of the uterus, ovary failure to receive or maintain egg cells. Moreover, the delay in pubertal development will lead to primary amenorrhea. It is defined as an absence of secondary sexual characteristics by age 14 with no menarche or normal secondary sexual characteristics but no menarche by 16 years of age. Secondary (cessation of menstrual cycles) amenorrhea is often caused by hormonal disturbances from the hypothalamus and pituitary gland, from premature menopause or intrauterine scar formation. It is defined as the absence of menstruation for three months in a woman with previously normal or nine months for women with a history of menstruation oligomenorrhea.
Amenorrhoea is divided into two categories:
Primary amenorrhoea – periods have not started by 14 years and there are no signs of other sexual characteristics (such as developing breasts and pubic hair), or periods have not started by 16 years, even though other sexual characteristics have developed.
Secondary amenorrhoea – periods have stopped for about six months
A range of factors can cause the hypothalamus to malfunction and trigger amenorrhoea, including:
•emotional stress
•weight loss
•excessive physical exercise
•certain medications used to treat mental health conditions
•disorders of the endocrine system, such as hypothyroidism (an underactive thyroid gland)
Some women are at greater risk of amenorrhoea caused by stress and weight loss.
Other disorders that can cause amenorrhoea include:
•Polycystic ovarian syndrome – the ovaries develop clusters of blister-like cysts. Symptoms include irregular periods and excessive hair growth. Women with polycystic ovarian syndrome are especially prone to amenorrhoea when they gain weight.
•Hyperandrogenaemia – the body produces high levels of male sex hormones, which can affect the reproductive system. This can be caused by ovarian or adrenal tumours, or certain conditions present at birth.
•Hyperprolactinaemia – the body produces high levels of the breastfeeding hormone prolactin. Levels rise due to overactivity of, or a tumour on, the pituitary gland.
•Ovarian failure or early menopause – low levels of oestrogen cause ovulation to fail, which stops the menstrual cycle.
•Abnormalities of the vagina – a sealed hymen, for example, can prevent menstrual blood from leaving the vagina. This is a rare condition and symptoms include a swollen abdomen, delayed periods and abdominal pain.
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Organisation:
•American Society for Reproductive Medicine
•Society for Assisted Reproductive Technologies
•American Board of Oriental Reproductive Medicine
•Reproductive Medicine Associates of New Jersey
•world association of reproductive medicine
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This page was last updated on November 5, 2024
