Amenorrhoea

Definition

Definition of Amenorrhoea
Amenorrhoea (BE), amenorrhea (AmE), or amenorrhœa, 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 forming the basis of a form of contraception known as the lactational amenorrhoea method. Outside of the reproductive years there is absence of menses during childhood and after menopause.

Types: Two types of this condition include “exercise amenorrhoea” and “drug-induced amenorrhoea”. In exercise amenorrhoea, women who perform too much exercise regularly are at risk of developing the condition. For many years, doctors believed that low levels of body fat and exercise-related chemicals can disrupt sex hormones. However, new studies have shown that the body composition and hormonal levels in patients with amenorrhoea are the same as normal women. Instead, women with amenorrhoea have low energy availability since women who exercise extremely do not have enough calories to maintain normal menstrual cycles. Exercise amenorrhoea can cause severe bone loss, which could result in osteopenia and osteoporosis. However, intervention and awareness can prevent this condition to occur in female athletes. Sports at high risk of causing exercise amenorrhoea include ballet, swimming, cycling, cross country, rowing, diving, track and field, gymnastics, figure skating and other strenuous sports. In drug-induced amenorrhoea, various medications such as contraceptives can induce amenorrhoea in healthy women. The lack of menstrual periods begins after starting the medications, which could last up to a year after stopping the medications.

Symptoms

Symptoms of Amenorrhoea
The main indication is that one might have amenorrhoea is that one don't have menstrual periods. Here's what to look for in primary and secondary amenorrhoea:

1. Primary amenorrhoea. Have no menstrual period by age 16.
2. Secondary amenorrhoea. Have no periods for three to six months or longer.

Causes

Causes of Amenorrhoea
Amenorrhoea is a symptom with many potential causes. Primary amenorrhoea (menstruation cycles never starting) may be caused by developmental problems such as the congenital absence of the uterus, failure of the ovary to receive or maintain egg cells, and genetic diseases such as 5-alpha-reductase deficiency which causes one to be intersex. Also, delay in pubertal development will lead to primary amenorrhoea. 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 amenorrhoea (menstruation cycles ceasing) is often caused by hormonal disturbances from the hypothalamus and the pituitary gland, from premature menopause or intrauterine scar formation. It is defined as the absence of menses for three months in a woman with previously normal menstruation or nine months for women with a history of oligomenorrhoea.

Diagnosis

Diagnosis of Amenorrhoea
Examination should include:

1. Height, weight and calculation of BMI. In young teenagers, centile charts are more appropriate as a BMI of 20 is overweight at age.
2. Check secondary sexual characteristics and note any galactorrhoea.
3. Pelvic examination should be omitted for a girl who denies previous sexual activity but abdominal examination is mandatory. There may be an unexpected mass arising from the pelvis, and after 16 weeks HCG falls and pregnancy tests are negative. Abdominal masses arising from the pelvis are not necessarily uterine. It may be a large ovarian cyst.

Treatment

Treatment of Amenorrhoea
Treatments for amenorrhoea vary on a case-to-case basis. For women with low estrogen levels, estrogen therapy may be used, while those with key issues may need surgical correction. Treatments are not needed if a woman has no plans of having biological children, especially if the cause of amenorrhoea is not life threatening. The best way to cure athletic amenorrhoea is to reduce the amount of exercise. On the other hand, drug-induced amenorrhoea can be cured by stopping medication on doctor's advice.

Prognosis

Prognosis of Amenorrhoea
The outcome depends on the cause. Most of the conditions that cause secondary amenorrhoea will respond to treatment.

Prevention

Prevention of Amenorrhoea
Prevention depends on the cause. For example, moderate exercise instead of extreme exercise, weight control, and other measures may be helpful.