Amenorrhea - Types, Causes, Symptoms, Diagnosis, and Treatment

Introduction :

Amenorrhea is referred to as the absence of a menstrual period. It is not a life-threatening condition; proper treatment and lifestyle changes can prevent it.

What Are the Types of Amenorrhea?

Amenorrhea is classified as, primary and secondary :

• Primary Amenorrhea - primary Amenorrhea is a rare condition. It happens due to changes in glands, hormones, and organs related to menstruation. It occurred when the first periods did not start during puberty.

• Secondary Amenorrhea - It occurs when patients have a regular period and then stop getting periods for at least three months, or patients have irregular periods and then stop getting periods for at least six months. Pregnancy, breastfeeding, illness, and stress are some possible causes.

What Are the Causes of Amenorrhea?

Primary Amenorrhea - causes of primary Amenorrhea may be due to genetic or anatomic issues. A disease affecting the pituitary gland and hypothalamus can also cause delayed periods because they play a role in regulating ovarian hormones.

Genetic conditions causing amenorrhea include:

• Turner Syndrome - In this condition, the ovaries are replaced by scar tissue and reduced estrogen production. Female genitalia and sex characteristics also stop occurring in tuners syndrome because of a decrease in estrogen.

• Gonadal Dysgenesis leads to premature failure of the ovaries. It is a common cause of primary Amenorrhea in young women.

• Mullerian Defect is an abnormal formation of the reproductive organs. This is usually a defect in the uterus and fallopian tube formation.

• Androgen Insensitivity Syndrome is a condition in which women are genetically male in each cell. People with this condition have external sex characteristics of a female with no uterus; therefore, no menstruation occurs.

Secondary Amenorrhea - There are many reasons for secondary Amenorrhea like

• Extreme weight loss.

• Physical or emotional stress.

• Severe illness.

• Vigorous exercise.

• Hypothyroidism.

• Disease or tumor of the pituitary gland.

• Polycystic ovarian syndrome.

• Premature ovarian failure.

• Ashermans syndrome.

• Chemotherapy and radiation therapy.

• Medications like antipsychotic drugs, antidepressant drugs, and allergic drugs.

What Are the Risk Factors of Amenorrhea?

The risk factors for Amenorrhea include :

• Family history of Amenorrhea.

• Eating disorders include bulimia (obsessive desire to lose weight) or anorexia (loss of appetite).

• Genetic or chromosomal conditions.

• Obesity or underweight.

• Over-exercising

• Emotional and physical stress.

• Chronic illness.

• Any history of gynecological procedures like D and C, loop electrodiathermy excision procedure (LEEP).

What Are the Symptoms of Amenorrhea?

The signs and symptoms vary depending upon the causes. The absence of periods is the main symptom.

Other symptoms include:

• Hair Loss.

• Headache.

• Acne.

• Pelvic pain.

• Excessive facial hair

• Milky discharge from the nipples.

• Vision changes.

• Vaginal discharge.

• Hot flashes.

• Deepening of the voice.

How Is Amenorrhea Diagnosed?

Diagnosis of Amenorrhea starts with a medical history and pelvic examination to check the reproductive organs. The doctor will suggest proper prenatal care if pregnancy is the reason behind Amenorrhea. If the patient has no history of the first period, the doctor may examine breasts and genitals to see if the patient is experiencing normal changes of puberty. Amenorrhea may be because of a complex set of hormonal problems.

Finding the underlying cause is significant, and the following tests are done to confirm Amenorrhea,

• Pregnancy Test - This test is done to confirm or rule out pregnancy.

• Ovary Function Test - By measuring the amount of follicle-stimulating hormone (FSH), the working condition of the ovary can be determined.

• Thyroid Function Test - This test helps measure the thyroid-stimulating hormone (TSH) in the blood; decreased TSH can cause Amenorrhea.

• Prolactin Test - decreased prolactin hormone may be because of pituitary gland tumor.

• Male Hormone Test - if the patient has a husky voice and increased facial hair, this test will help determine the amount of male hormone in the blood.

• Hormone Challenge Test/Progestogen Challenge Test - This test is performed by giving progesterone (female sex organ) as an injection or tablet, which triggers menstruation within 2 to 7 days; this indicates patients amenorrhea is due to issues in ovulation.

• Ultrasound - sound waves produced by the device help to show the image of internal organs and check for any abnormalities in the reproductive system.

• Magnetic Resonance Imaging (MRI) - the detailed image of soft tissue can be seen with the MRI. Any abnormalities in the pituitary gland and hypothalamus can be ruled out using MRI.

• Hysteroscopy - If other tests do not reveal the cause, then hysteroscopy is used to examine the uterus.

What Are the Treatment Options for Amenorrhea?

Treatment of Amenorrhea depends on the cause. The treatment plan will establish menstruation, correct the hormonal imbalance, achieve fertility, and prevent any complications.

Primary Amenorrhea - The treatment depends on the age and the ovary function test result. Physicians will recommend the surgery if there are physical or genetic variations of the reproductive organs.

Secondary Amenorrhea - Secondary amenorrhea is caused mainly due to lifestyle factors and underlying medical conditions; the healthcare professionals will suggest changes in that required area:

• Changes in Lifestyle - Vigorous exercise may be a reason for Amenorrhea, so changes in the exercise routine and diet will help fix the issues.

• Gaining Weight - Excessive weight loss can also cause Amenorrhea; treatment may include weight gaining diet plans by consulting a nutritionist or dietitian.

• Stress - emotional and mental stress is a leading cause of Amenorrhea. Stress management techniques and counseling will be helpful.

• Thyroid - If Amenorrhea is due to the thyroid, the physician will recommend treatments to regulate thyroid hormone.

• Polycystic Ovary Syndrome (PCOS) - The physician will recommend some weight loss diet and lifestyle changes to prevent PCOS.

• Hormone Replacement Therapy (HRT) - Premature ovary failure can be treated by HRT.

Treatment to Relieve the Side Effects of Amenorrhea - Patients will also have symptoms like vaginal dryness, fatigue, and weak bones; doctors will prescribe treatment like estrogen therapy to relieve inflammation and vaginal dryness, and calcium and vitamin supplements to strengthen bones.

What Are the Complications of Amenorrhea?

A significant complication of Amenorrhea is infertility because of reproductive organ dysfunction. Other complications include osteopenia (reduction in bone density) and osteoporosis (bone becomes weak and brittle) in old age due to prolonged Amenorrhea.

How to Prevent Amenorrhea?

Amenorrhea is preventable by controlling the underlying cause, like maintaining a healthy lifestyle by controlling weight and eating healthy. Keep track of the menstrual cycle so delays in periods can be easily noticed. Maintain regular and adequate sleep.

Conclusion:

Amenorrhea is referred to when menstruation does not occur for a long duration. This may be due to hormonal, genetic, or lifestyle changes. By identifying the cause, proper treatment can be provided.