amenorrhea

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Amenorrhea

 

Definition

The absence of menstrual periods is called amenorrhea. Primary amenorrhea is the failure to start having a period by the age of 16. Secondary amenorrhea is more common and refers to either the temporary or permanent ending of periods in a woman who has menstruated normally in the past. Many women miss a period occasionally. Amenorrhea occurs if a woman misses three or more periods in a row.

Description

The absence of menstrual periods is a symptom, not a disease. While the average age that menstruation begins is 12, the range varies. The incidence of primary amenorrhea in the United States is just 2.5%.
Some female athletes who participate in rowing, long distance running, and cycling, may notice a few missed periods. Women athletes at a particular risk for developing amenorrhea include ballerinas and gymnasts, who typically exercise strenuously and eat poorly.

Causes and symptoms

Amenorrhea can have many causes. Primary amenorrhea can be the result of hormonal imbalances, psychiatric disorders, eating disorders, malnutrition, excessive thinness or fatness, rapid weight loss, body fat content too low, and excessive physical conditioning. Intense physical training prior to puberty can delay menarche (the onset of menstruation). Every year of training can delay menarche for up to five months. Some medications such as anti-depressants, tranquilizers, steroids, and heroin can induce amenorrhea.

Primary amenorrhea

However, the main cause is a delay in the beginning of puberty either from natural reasons (such as heredity or poor nutrition) or because of a problem in the endocrine system, such as a pituitary tumor or hypothyroidism. An obstructed flow tract or inflammation in the uterus may be the presenting indications of an underlying metabolic, endocrine, congenital or gynecological disorder.
Typical causes of primary amenorrhea include:
  • excessive physical activity
  • drastic weight loss (such as occurs in anorexia or bulimia)
  • extreme obesity
  • drugs (antidepressants or tranquilizers)
  • chronic illness
  • turner's syndrome. (A chromosomal problem in place at birth, relevant only in cases of primary amenorrhea)
  • the absence of a vagina or a uterus
  • imperforate hymen (lack of an opening to allow the menstrual blood through)

Secondary amenorrhea

Some of the causes of primary amenorrhea can also cause secondary amenorrhea—strenuous physical activity, excessive weight loss, use of antidepressants or tranquilizers, in particular. In adolescents, pregnancy and stress are two major causes. Missed periods are usually caused in adolescents by stress and changes in environment. Adolescents are especially prone to irregular periods with fevers, weight loss, changes in environment, or increased physical or athletic activity. However, any cessation of periods for four months should be evaluated.
The most common cause of seconardy amenorrhea is pregnancy. Also, a woman's periods may halt temporarily after she stops taking birth control pills. This temporary halt usually lasts only for a month or two, though in some cases it can last for a year or more. Secondary amenorrhea may also be related to hormonal problems related to stress, depression, anorexia nervosa or drugs, or it may be caused by any condition affecting the ovaries, such as a tumor. The cessation of menstruation also occurs permanently after menopause or a hysterectomy.

Diagnosis

It may be difficult to find the cause of amenorrhea, but the exam should start with a pregnancy test; pregnancy needs to be ruled out whenever a woman's period is two to three weeks overdue. Androgen excess, estrogen deficiency, or other problems with the endocrine system need to be checked. Prolactin in the blood and the thyroid stimulating hormone (TSH) should also be checked.
The diagnosis usually includes a patient history and a physical exam (including a pelvic exam). If a woman has missed three or more periods in a row, a physician may recommend blood tests to measure hormone levels, a scan of the skull to rule out the possibility of a pituitary tumor, and ultrasound scans of the abdomen and pelvis to rule out a tumor of the adrenal gland or ovary.

Treatment

Treatment of amenorrhea depends on the cause. Primary amenorrhea often requires no treatment, but it's always important to discover the cause of the problem in any case. Not all conditions can be treated, but any underlying condition that is treatable should be treated.
If a hormonal imbalance is the problem, progesterone for one to two weeks every month or two may correct the problem. With polycystic ovary syndrome, birth control pills are often prescribed. A pituitary tumor is treated with bromocriptine, a drug that reduces certain hormone (prolactin) secretions. Weight loss may bring on a period in an obese woman. Easing up on excessive exercise and eating a proper diet may bring on periods in teen athletes. In very rare cases, surgery may be needed for women with ovarian or uterine cysts.

Key terms

Hymen — Membrane that stretches across the opening of the vagina.
Hypothyroidism — Underactive thyroid gland.
Hysterectomy — Surgical removal of the uterus.
Turner's syndrome — A condition in which one female sex chromosome is missing.

Prognosis

Prolonged amenorrhea can lead to infertility and other medical problems such as osteoporosis (thinning of the bones). If the halt in the normal period is caused by stress or illness, periods should begin again when the stress passes or the illness is treated. Amenorrhea that occurs with discontinuing birth control pills usually go away within six to eight weeks, although it may take up to a year.
The prognosis for polycystic ovary disease depends on the severity of the symptoms and the treatment plan. Spironolactone, a drug that blocks the production of male hormones, can help in reducing body hair. If a woman wishes to become pregnant, treatment with clomiphene may be required or, on rare occasions, surgery on the ovaries.

Prevention

Primary amenorrhea caused by a congenital condition cannot be prevented. In general, however, women should maintain a healthy diet, with plenty of exercise, rest, and not too much stress, avoiding smoking and substance abuse. Female athletes should be sure to eat a balanced diet and rest and exercise normally. However, many cases of amenorrhea cannot be prevented.

Resources

Periodicals

Hogg, Anne Cahill. "Breaking the Cycle: Often Confused and Frustrated, Sufferers of Amenorrhea Now have Better Treatment Options." American Fitness 15, no. 4 (July-August 1997): 30-4.

Organizations

American College of Obstetricians and Gynecologists. 409 12th St., S.W., P.O. Box 96920, Washington, DC 20090-6920. http://www.acog.org.
Federation of Feminist Women's Health Centers.1469 Humboldt Rd, Suite 200, Chico, CA 96928. (530) 891-1911.
National Women's Health Network. 514 10th St. NW, Suite 400, Washington, DC 20004. (202) 628-7814. http://www.womenshealthnetwork.org.

amenorrhea

 [a-men″o-re´ah]
absence of the menses. adj., adj amenorrhe´al.Primary amenorrhea refers to absence of the onset of menstruation at puberty or before age 18; it may be caused by underdevelopment or malformation of the reproductive organs or by endocrine disturbances. When menstruation has begun and then ceases, the term secondary amenorrhea is used. The most common cause of this is pregnancy, but if that is excluded, there is usually a disturbance of the endocrine glands concerned with the menstrual process. General ill health, a change in climate or living conditions, emotional shock or, frequently, either the hope or fear of becoming pregnant can sometimes stop the menstrual flow.
dietary amenorrhea cessation of menstruation accompanying loss of weight due to dietary restriction, the loss of weight and of appetite being less extreme than in anorexia nervosa and unassociated with psychological problems.
hypogonadotropic amenorrhea cessation of menstruation due to failure to maintain a critical body fat-to-lean ratio, resulting in hypothalamic suppression; seen in women who engage in strenuous exercise, such as athletes, dancers, and those who are excessively weight conscious.
lactation amenorrhea absence of the menses in association with lactation.
nutritional amenorrhea dietary a.

a·men·or·rhe·a

(ă-men'ō-rē'ă),
Absence or abnormal cessation of the menses.
[G. a- priv. + mēn, month, + rhoia, flow]

amenorrhea

/amen·or·rhea/ (ah-men″o-re´ah) absence or abnormal stoppage of the menses.amenorrhe´al
primary amenorrhea  failure of menstruation to occur at puberty.
secondary amenorrhea  cessation of menstruation after it has once been established at puberty.

amenorrhea

(ā-mĕn′ə-rē′ə)
n.
Abnormal suppression or absence of menstruation.

a·men′or·rhe′ic, a·men′or·rhe′al adj.

amenorrhea

[ā′menərē′ə]
Etymology: Gk, a, men, not month, rhoia, to flow
the absence of menstruation. Amenorrhea is normal before sexual maturity, during pregnancy, after menopause, and during the intermenstrual phase of the monthly hormonal cycle; it is otherwise caused by dysfunction of the hypothalamus, pituitary gland, ovary, or uterus; by the congenital absence or surgical removal of both ovaries or the uterus; or by medication. It may also occur in women who are underweight or who exercise extensively. Primary amenorrhea is the failure of menstrual cycles to begin. Secondary amenorrhea is the cessation of menstrual cycles once established. Also spelled amenorrhoea. See also dietary amenorrhea,hypothalamic amenorrhea,postpill amenorrhea. amenorrheic, adj.

amenorrhea

Gynecology The absence or abnormal cessation of menses, which may be 1º–no menstrual period by age 16, or 2º–menses stops for ≥ 6 months in a ♀ in whom normal menstruation was established or for 3 normal intervals in a ♀ with oligomenorrhea Scope 1º amenorrhea affects 2.5% of US ♀; 2º amenorrhea affects 3% of the population; it is most common in Pts under extreme stress Impact Amenorrheic ♀ do not ovulate, which makes them inconceivable; amenorrhea accompanied by absence of estrogen is linked to genital atrophy and osteoporosis; amenorrhea with minimal estrogen is linked to endometrial hyperplasia; ♀ with 1º amenorrhea may suffer psychosocial and psychosexual problems. See Post-pill amenorrhea.

a·men·or·rhe·a

(ā-menŏ-rēă)
Absence or abnormal cessation of the menses.
Synonym(s): amenorrhoea.
[G. a- priv. + mēn, month, + rhoia, flow]

a·men·or·rhe·a

(ā-menŏ-rēă)
Absence or abnormal cessation of the menses.
Synonym(s): amenorrhea.
[G. a- priv. + mēn, month, + rhoia, flow]

amenorrhea (əmen´ōrē´ə),

n the absence or abnormal cessation of the menstrual cycle.
References in periodicals archive ?
When comparing chronic estrogen suppression in amenorrheic athletes to the cyclical fluctuation of estrogen in eumenorrheic athletes, it is more accurate to assess estrogen status and ovulation with daily urinary analysis of estrogen metabolites throughout the menstrual cycle (O'Donnell et al.
Bone mineral content of amenorrheic and eumenorrheic athletes.
In contrast, in the sample of men, most believed women are fertile only when no longer amenorrheic.
Misra and colleagues enrolled 21 girls who were amenorrheic athletes, 19 eumenorrheic athletes, and 18 nonathletic controls.
Women generally do not become amenorrheic with cyclic progesterone.
However, 16 of the 19 patients were still amenorrheic at the end of the observation period.
In addition, recent research suggests that amenorrheic athletes are at risk for cardiovascular disease.
Westoff (1988, 1988a) also suggested estimating the potential demand for contraceptives for spacing and for limiting births, and he incorporated pregnant and recently amenorrheic women whose pregnancy was unintentional.
Pregnant and amenorrheic women are considered to have an unmet need if they say that their current or last pregnancy was unintended.
Studies have shown that ovulation usually begins about 6 weeks after supplemental feeding begins, and that supplemental feeding increases the chance of ovulation even in amenorrheic women.
This case report suggests that bone density and fertility may not be completely jeopardised in formerly amenorrheic and osteopenic athletes, providing recovery through diet, weight gain, and return of menstruation is achieved within the third decade.
Anorectic women not receiving oral contraceptives had been amenorrheic for at least 3 consecutive months and had not received hormonal contraceptives within the previous 3 months.