• Amenorrhea

Amenorrhoea is the absence of a menstrual period in a woman of reproductive age. Physiological states of amenorrhoea are seen, most commonly, 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.

Amenorrhoea is a symptom with many potential causes. Primary amenorrhoea (menstrual 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.

Secondary amenorrhoea (menstrual 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.

Secondary amenorrhea can occur due to natural changes in the body. For example, the most common cause of secondary amenorrhea is pregnancy. Breastfeeding and menopause are also common, but natural, causes.

Women who take birth control pills or who receive hormone shots such as Depo-Provera may not have any monthly bleeding. When they stop taking these hormones, their periods may not return for more than 6 months.

You are more likely to have absent periods if you:

  • Are obese
  • Exercise too much and for long periods of time
  • Have very low body fat (less than 15 to 17%)
  • Have severe anxiety or emotional distress
  • Lose a lot of weight suddenly (for example, from strict or extreme diets or after gastric bypass surgery)

Other causes include:

Also, procedures such as a dilation and curettage (D and C) can cause scar tissue to form. This tissue may cause a woman to stop menstruating. This is called Asherman syndrome. Scarring may also be caused by some severe pelvic infections.

Symptoms

In addition to having no menstrual periods, other symptoms can include:

  • Breast size changes
  • Weight gain or weight loss
  • Discharge from the breast or change in breast size
  • Acne and increased hair growth in a male pattern
  • Vaginal dryness
  • Voice changes

If amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the tumor, such as vision loss and headache.

Exams and Tests

A physical exam and pelvic exam must be done to check for pregnancy. A pregnancy test will be done.

Blood tests may be done to check hormone levels, including:

Other tests that may be performed include:


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Amenorrhea

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