Amenorrhea

Also found under: Menstrual Disorders
What is it?
The term menstrual disorders refers to any of a number of conditions that are related to the menstrual cycle. Menstruation is the shedding of the lining of the uterus (the endometrium) each month, also referred to as the menstrual period. Menstrual periods usually last for five to seven days. Amenorrhea is the term used to describe the absence of menstrual periods. There are two types of amenorrhea. Primary amenorrhea refers to menstrual periods that have not begun by the age of 16. Secondary amenorrhea refers to the absence of three or more menstrual periods in a woman who has had regular periods up to that point. A menstrual period is considered late if it is five or more days overdue according to the woman's usual pattern of periods. A period is considered missed if there is no menstrual flow for 6 or more weeks.
Who gets it?
Any female who has begun menstruating can experience secondary amenorrhea. Girls who do not undergo puberty, the stage of sexual growth during which the breasts begin to bud and the first menstrual period begins, experience primary amenorrhea.
What causes it?
Problems with the uterus, cervix, ovaries, and hormones can cause amenorrhea. The main cause of primary amenorrhea is delayed puberty. Delayed puberty can be caused by a hormonal problem; a birth defect in which the vagina, uterus, or fallopian tubes don't develop normally; or by chromosomal disorders. Chromosomal disorders include Turner's syndrome, in which the cells contain only one X chromosome instead of the two that should be present in females. In rare cases, puberty does not occur because the child may develop as a female, but is genetically male. This may be occur in children born with both sex organs, called hermaphrodites, or with a condition called male pseudohermaphroditism. Both primary and secondary amenorrhea can be caused by high or low levels of thyroid hormones and by Cushing's syndrome, a condition in which the adrenal glands produce too much corticosteroid hormone. The most common cause of secondary amenorrhea in adult women and teenagers is pregnancy. However, many teenagers have irregular periods during the first few years. Breastfeeding, discontinuing birth control pills, physical or emotional stress, depression, malnutrition, drugs used to treat stress and depression, and sudden weight loss or gain can also cause periods to stop. Other causes of secondary amenorrhea can be related to medical conditions such as traumatic brain injury; brain, ovary, or adrenal gland tumors; ovarian cysts; overproduction of prolactin by the pituitary gland; chronic illness; and Asherman's syndrome, which is scarring of the uterine lining caused by infection or surgery. Strenuous exercise can also cause delayed onset of menstruation or missed periods, and is often seen in young female athletes. When menstrual periods stop occurring after menopause, it is called permanent secondary amenorrhea.
What are the symptoms?
Symptoms of amenorrhea vary depending upon the cause. For example, if primary amenorrhea is caused by the failure to undergo puberty, symptoms will include lack of or below normal development of breasts and pubic and underarm hair. If the cause is related to high thyroid hormones, the symptoms will include anxiety, rapid heartbeat, and warm, moist skin. Cushing's syndrome causes symptoms including a round face, enlarged abdomen, and thin arms and legs. When secondary amenorrhea is caused by pregnancy, other signs of early pregnancy may be present, such as nausea, breast swelling, or weight gain. Asherman's syndrome usually produces no symptoms.
How is it diagnosed?
To diagnose amenorrhea, your doctor will take a complete medical history and will perform a physical examination, including a pelvic, or internal, exam. This doctor would most likely be your gynecologist, a doctor who specializes in women's reproductive health. He or she will ask questions about your lifestyle, diet, sexual activity, and any medications you are taking. The doctor will first look for obvious causes of your symptoms. For example, he or she will look for signs of puberty in a teenager who has never gotten her period. If you are sexually active and have had a normal period before your symptoms began, the doctor will order a pregnancy test. A blood sample will reveal if estrogen or the hormones produced by the pituitary, adrenal, or thyroid glands are at abnormal levels. If your doctor suspects a brain tumor or other brain injury is causing your symptoms, he may order a skull x-ray. Tumors of the ovaries or adrenal glands, as well as cysts, can be detected by computed tomography (CT) or ultrasound scans of the abdomen. Your doctor may recommend genetic testing if he suspects a chromosomal disorder such as Turner's syndrome. If your doctor finds nothing abnormal in your exam or tests, irregular periods may be normal for you at this time. This is especially common in teenagers.
What is the treatment?
The treatment of amenorrhea depends on the cause of the problem. If you are pregnant, treatment involves a good program of prenatal care. If symptoms are caused by delayed puberty, the doctor will monitor your progress at regular checkups, often every three to six months. He or she may recommend hormonal supplements of progesterone and/or estrogen to induce puberty. Tumors or cysts are usually treated with surgery, as is an abnormally developed vagina. If high levels of stress are causing your symptoms, your doctor will help you develop a plan for cutting back on some activities or avoiding situations that cause you stress. A therapist may be helpful in these situations. Amenorrhea caused by extreme dieting will resolve itself, and normal periods should start, once a healthy diet is followed. If your doctor finds no cause of your symptoms and you are otherwise healthy, you may simply have an irregular cycle and do not need treatment. Some causes, such as Turner's syndrome, cannot be cured.
Self-care tips
Always check with your doctor if you miss more than one menstrual period, especially if you are sexually active and have not used birth control. If you are overweight, avoid extreme diets that deprive you of the calories you need to stay active and maintain a normal energy level. If you have an irregular cycle, try keeping a record of when your period starts and stops each month. This information will be helpful if you need to see your doctor about your symptoms. Avoid cigarette smoking, recreational drugs, and excessive use of alcohol. Also avoid situations that you know cause extreme stress. If you are involved in strenuous physical activity, you may need to cut back on your program to help your periods become regular again.