Amenorrhea

Amenorrhea is the absence of menstruation. Girls who haven't begun to menstruate by age 16 are said to have primary amenorrhea. Secondary amenorrhea is the absence of menstruation for three months or longer after menstruation has already begun.


Causes/associated factors
To determine the underlying cause of primary amenorrhea, a medical exam is important. If you have no pubic hair or your breasts haven't begun to develop by age 16, the condition may be hormonal or genetic. Often, the hypothalmus (an area of the brain that has many functions, including regulating body temperature and water balance) doesn't produce enough of a particular hormone that eventually leads to sexual maturation during puberty.
When sexual development is normal, amenorrhea can be caused by structural abnormalities that may occur when the reproductive organs don't form properly before birth (such as physical blockages of the menstrual flow or an incompletely formed uterus). However, primary amenorrhea accompanied by normal sexual development of pubic hair and breasts can also be caused by most of the same factors as secondary amenorrhea.

Secondary amenorrhea is much more common than primary amenorrhea. The condition may be caused by various factors, including:

pregnancy
breastfeeding
hormone imbalances
uterine or ovarian disorders
tumors in the pituitary or adrenal glands
severe emotional stress
oral contraceptives or other medications
infections or other illnesses
malnutrition or poor eating habits
drastic changes in weight, including severe weight loss or anorexia
obesity
a recent injury
previous radiation or chemotherapy
chronic disease (such as Crohn's disease, sickle cell disease, AIDS or cystic fibrosis)
Amenorrhea may also occur in women who engage in vigorous exercise or competitive sports, sometimes referred to as athletic amenorrhea. This condition is most common in adolescents and must always be taken seriously. Menstrual dysfunction shouldn't be considered a normal response to exercise.


Signs/symptoms
Some women have no symptoms other than the absence of menstruation. Depending on the cause and whether you have primary or secondary amenorrhea, other symptoms may include:
weight, hair or appetite changes
unusual bruising
hot flashes or night sweats
increased or unusual sensitivity to heat or cold
muscle wasting
headaches
vision changes
breast discharge (often milk production not associated with pregnancy)
vaginal dryness
changes in sex drive
changes in mood or mental function
If you experience any of these symptoms, consult your doctor for further evaluation.


Diagnosis
Amenorrhea is expected before puberty, during pregnancy and lactation, and after menopause. When it occurs any other time, it's best to consult your doctor. He or she will ask questions about your medical history and do a physical exam. You may need a pregnancy test or blood tests to check various hormone levels.
Depending on the blood test results, you may need a progesterone stimulation test or other tests, such as magnetic resonance imaging (MRI, an imaging technique based on computer analysis of the body's response to a magnetic field) or a computed tomography scan (CT scan, a computer-generated, cross-sectional picture of internal body parts) of the pituitary gland. These tests can help the doctor identify certain abnormalities, such as rare pituitary tumors.

An endometrial biopsy (taking a tissue sample from the endometrium, the tissue that lines the uterus) may be done to evaluate ovarian function and detect cancerous or other abnormal changes in the uterus. A transvaginal or abdominal ultrasound may also be done to check for structural abnormalities in the pelvis area.


Treatment
Amenorrhea can often be corrected. Based on the underlying cause, treatment options may include stress management, lifestyle modifications, hormone therapy or surgery. Discuss the risks and benefits of each treatment option and the need for follow-up appointments with your doctor. Ask what warning signs may indicate a change in your condition.

Complications
The risk of complications varies. Amenorrhea can be a symptom of an underlying medical problem that may lead to conditions such as infertility, osteoporosis, heart disease, degeneration of the genital organs, endometrial cancer, or, if sexual characteristics aren't developed, social and sexual problems as well.
In some cases, amenorrhea may lead to decreased bone mineral density or osteoporosis. The bone loss increases with the length of time the amenorrhea lasts, so be sure to see your doctor promptly if you suspect anything is interfering with your menstrual cycle. You may need screening tests for osteoporosis, as well as treatment with hormones or calcium supplementation.


Prevention
Generally, it's important to:
Eat a well-balanced diet.
Cope effectively with stress.
Exercise regularly at an appropriate level for your age and health status.
If you're having difficulty in any of these areas, discuss your concerns with your doctor. To modify your risk factors for osteoporosis, he or she may recommend hormone replacement therapy, calcium supplements or lifestyle changes.