What is Amenorrhoea?
Absence of menstruation is called amenorrhea. Women who have missed at least three menstrual periods and girls who haven’t begun menstruation by the age of 16 are considered to have amenorrhea.
The most common natural cause of amenorrhea is pregnancy. Hormonal imbalance or problems with reproductive organs causes amenorrhea.
Cause of amenorrhea should be diagnosed immediately in girls and women who?
• are around 12–13 years of age.
• are not pregnant.
• have not had surgery to remove part or all of their womb
• Have not yet gone through the menopause.
The hypothalamus stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH cause the ovaries to produce the hormones estrogen and progesterone. Estrogen and progesterone are responsible for the cyclical changes in the endometrium (uterine lining), including menstruation. In addition, a woman’s genital tract should be normal without any abnormalities to allow the passage of menstrual blood.
Natural amenorrhea occurs in conditions like Pregnancy, breast feeding, Menopause.Types of Amenorrhoea
• Primary amenorrhea:
Absence of menstruation and secondary sexual characteristics e.g. breast development and pubic hair by 14 years or normal development of secondary sexual characteristics with absence of menstruation 16 years.
• Secondary amenorrhea:
A woman experience absence of periods for three or more months in the absence of pregnancy, lactation, contraceptive pills, or menopause.
Amenorrhea can result because of an abnormality in the hypothalamic-pituitary-ovarian axis, anatomical abnormalities of the genital tract, or functional causes.
1. Hypothalamic causes:
• Tumor near the pituitary gland.
• Low body weight or delayed growth.
• Kallmann syndrome.
• Nutritional deficiency.
2. Pituitary causes:
• Tumor of the pituitary gland.
• Cells of the pituitary gland is destroyed by the body’s own defense system called autoimmune hypophysitis.
3. Ovarian causes and abnormalities of genital tract:
• Polycystic ovary syndrome.
• Premature ovarian failure.
• Turner syndrome.
• High levels of male hormones.
• Radiation or chemotherapy.
• Intrauterine adhesions.
• Absence of the vagina, the cervix, or the uterus.
• Pure gonadal dysgenesis.
• Autoimmune oophoritis in which cells of the ovaries destroyed by the body’s own defense system.
4. Functional causes:
• Excessive stress.
• Depression or other psychiatric disorders.
• Birth control pills.
• Chronic diseases.
• Excessive weight gain or loss.
• Drug abuse.
• Excessive exercise.
The main symptom is absence of menstrual discharge. Other associated symptoms may produce following symptoms:
• Headache or reduced peripheral vision.
• Increased hair growth on face.
• Vaginal dryness.
• Heat flashes or night sweats.
• Disturbed sleep.
• Marked weight gain or weight loss.
• Excessive anxiety.
• Physical examination:
Pelvic exam will be done to check any problems with reproductive organs.
• Lab test:
– Pregnancy test
– Ovary function test
– Male hormone test
– Thyroid function test
• Imaging tests:
– CT scan
• Anxiety Disorders
• Congenital Adrenal Hyperplasia
• Ovarian Insufficiency
• Follicle-Stimulating Hormone Abnormalities
• Pregnancy Diagnosis
• Cushing Syndrome
• Luteinizing Hormone Deficiency
• Medications for cause of disease.
• In some cases contraceptive pills starts menses.
• Hormone replacement therapy.
• Surgery in cases of structural blockage.
Prognosis depends on the cause of the amenorrhea. Patient may feel depressed. Diagnosis of underlying disease and proper treatment has a good prognosis.
• Because of low estrogen level osteoporosis can happen.
• Suppression from working in cold water.
• Blood rushes to the head and chest.
• Suited to fat, flabby, chilly and anaemic pateint.
• Amenorrhoea due to suppressed foot-sweat.
• Cramping pain in chest and abdomen.
• Periods suppressed from getting feet wet.
• Suited in feeble and debilitated pateint.
• Leucorrhoea occurs instead of menses.
• Suppression of periods in plethoric girls.
• Marked fear and restlessness.
• Sharp pain in womb.
• Distended abdomen or dropsical swelling.
• Menses absent in tropical conditions.
• Weakness and nervousness due to absence of menses.
• Delayed or scanty menses.
• There is associated constipation.
• Suited to patient who are fat, chilly and takes cold easily.
• There is a feeling as if menses will appear but does not happen.
• Muscular fatigue and weariness.
• Depression or loss of sexual desire in women.
• Absence of menses occurs because of endocrine disorders.
• Indicated in rheumatic, nervous subjects with ovarian irritation, uterine cramps and heavy limbs.
• Electric shock like pain, that occurs here and there.
• Facial blemishes develops in young women.
• Instead of menses bleeding occurs from eyes, nose.
• Profuse, corrosive leucorrhea instead of menses.
• Suppressed menses due to grief.
• Changeable mood in females.
• Suited to patient with dark complexion and mild disposition.
Patient must maintain a record of occurrence of periods and changes in cycle.
Amenorrhea can cause mental stress to a woman. patient must seek support from family or freinds or doctors to overcome stress.
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