Amenorrhea

Overview

Amenorrhea is the absence of menstruation It is a common feature in pregnancy, postmenopausal and prepubertal females. Someone has amenorrhea when they missed 3 menstrual periods in a row or have yet to begin menstruation by age 15.

Signs and Symptoms

Absence of menstruation at least 3 times in a row, Have yet to begin menstruation by the age of 15, Acne, Pelvic pain, Milky nipple discharge, Excess facial hair, Hair loss, Vision changes, Headache

Common Causes

Menopause, Pregnancy, Breastfeeding, Usage of oral contraceptive pills, injected or implanted contraceptives, Certain medications such as antidepressants, antipsychotics, antihypertensives and chemotherapy, Polycystic ovarian syndrome (PCOS), Hyperthyroidism or hypothyroidism, Hyperprolactinemia, Congenital abnormalities such as constitutional delay or gonadotropin releasing hormone (GnRH) deficiency, Premature ovarian failure, Pituitary tumour, Asherman's syndrome, Structural abnormality of the female reproductive system, Excessively low body weight, Excessive exercise

Risk Factors

Family history of amenorrhea, Excessive athletic training

Investigation Techniques

Medical, childhood growth and development, family and sexual history, Physical examination, Pelvic examination, Serum or urinary human chorionic gonadotropin, Full blood count, Urinalysis, Hormonal studies including levels of prolactin, follicular stimulating hormone (FSH), luteinising hormone (LH), estradiol, thyroid hormones, estosterone and dehydroepiandrosterone sulfate, Pelvic ultrasound, Hysteroscopy, Magnetic resonance imaging (MRI) scan of the hypothalamus and pituitary area, Questionnaires such as modifiable activity questionnaire and multidimensional eating disorder inventory

Treatment and Prevention

Nutritional counseling, Maintain a healthy weight, Treatment of underlying cause, Hormone therapy with estrogen and progestin, Cyclic progesterone therapy, Dopamine agonists for example bromocriptine or cabergoline, Gonadotropin therapy or pulsatile gonadotropin releasing hormone (GnRH) therapy, Oral contraceptive pills, Metformin, Behavioural modification, Surgical removal of tumours

Psychological Issues

Eating disorders such as anorexia nervosa or bulimia nervosa, Stress