Amenorrhea Causes Symptoms Diagnosis Treatment

When a woman of childbearing age fails to begin menstruation, it is referred to as amenorrhea. A woman generally menstruates every 21 to 35 days. In case if she misses her menstrual cycle for three consecutive months or more, and is also not pregnant, she is said to have developed amenorrhea.

This condition can occur in girls who are above 16 years of age and have not yet begun menstruation or shown any signs of sexual development. Thus, amenorrhea is of two types:

Primary amenorrhea where young girls of 16 years or above fail to menstruate or show any signs of sexual development.

Secondary amenorrhea which occurs in women who previously were under a normal menstrual cycle and have suddenly missed three cycles in a row.

CAUSES
Primary amenorrhea may be caused if the teenage girl is very thin or is an athletic personality involved in excessive physical exercises. Generally such girls tend to remain underweight and do not show any puberty-related increase in body fat and hence fail to menstruate. Sometimes, primary amenorrhea may also be triggered by various genetic factors or abnormalities in the female reproductive organs.

Secondary amenorrhea most commonly occurs due to pregnancy. Other causes of secondary amenorrhea may include breastfeeding, menopause, premature ovarian failure, use of hormonal birth control contraceptives, presence of polycystic ovary syndrome (PCOS), hysterectomy (surgical removal of the uterus), and excessive production of hormones like testosterone in females.

SYMPTOMS
Amenorrhea is a symptom in itself characterised by complete absence or late onset of periods. There may be other symptoms depending upon the underlying cause. For example, if amenorrhea is caused due to increase in Prolactin levels, it may lead to a milky discharge from the nipples (called as galactorrhea). Other symptoms observed may include excessive growth of facial hair, acne, pelvic pain, dry skin and vision problems.

Risk factors for amenorrhea include
Excessive weight loss
Birth defects
Hormonal abnormalities
Emotional distress
Conditions such as thyroid disorders or pituitary tumors

DIAGNOSIS
Diagnosis depends upon the type of amenorrhea present i.e., primary or secondary. In case if a girl has never had her periods before (primary amenorrhea), the health care provider asks for a complete medical history and does a thorough physical examination including pelvic examination to check if there is a development of any other signs of puberty. Further investigations rely upon the results of the above examination.

In case of secondary amenorrhea, the health care provider records details of the last cycle experienced, pregnancy, medications if any, etc. Other tests that may be required for confirmed diagnosis of amenorrhea include blood test and imaging tests as mentioned below:

Thyroid function tests These highlight thyroid function status, as its irregular functioning may cause menstrual abnormalities including amenorrhea.

Ovary function tests These include testing for levels of hormones like FSH (follicle stimulating hormone) and LH (luteinising hormone) to determine the functioning efficiency of the ovaries.

Hormone challenge test This involves administration of an external hormonal supplement for 7-10 days to trigger a menstrual cycle. This test can reveal if estrogen hormone deficiency is responsible for the missing periods.

Ultrasound imaging test These tests create an image of the entire reproductive system, to enable detection of any structural abnormality or presence of cysts

PET-PET-CT Scan A higher version imaging system utilised for analysing the structure of uterus, ovaries and kidneys.

MRI scan These may be recommended to diagnose presence of pituitary tumors.

TREATMENT
Primary amenorrhea caused due to late onset of puberty is generally not a worry or concern as with some initial medications, the menstrual cycle can be initiated. However, if caused due to genetic abnormalities, treatments may not work as a cure but can only be used for managing the condition. In case of developmental abnormality, a surgical intervention, followed by some hormonal supplements may work.

Other factors responsible for causing amenorrhea can be treated in the following ways :
Stress It can be managed by incorporating stress busting activities like yoga, meditation or a breathing exercise.
Excessive physical strain Avoidance of excessive physical activity is imperative to aid in curing this condition. Indoor exercises can be practised, which only flex our muscles and not tire our system.
Lifestyle Activities like Smoking, drinking and drug abuse also affect the hormone levels and hence it is imperative to abstain from them in this condition.
Obesity The presence of excessive flab also leads to hormonal imbalance in certain cases and has been shown to be a major causative factor for primary amenorrhea. Avoid development of the same especially in young girls by inclusion of healthy diet and exercise regime.

Thus, amenorrhea is a condition and not a disease. It does not make a girl impotent, and can be easily cured as well as managed. Recognising the contributing factor and eliminating or treating the underlying cause becomes imperative here.