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Amenorrhea is the ABSENCE of menstrual periods in a woman of reproductive age. Absence of menses is normal in pregnant, breastfeeding and menopausal women, but pathological otherwise. Amenorrhea is not a disease on its own, but rather a symptom of a variety of underlying conditions. PRIMARY amenorrhea is when a woman has NEVER had her periods, while SECONDARY amenorrhea is when a woman has STOPPED having them.
Menstruation is part of the menstrual cycle, the monthly events that occur within a woman’s body in preparation for the possibility of pregnancy. Each month, an egg is released from an ovary in a process called ovulation. At the same time, the lining of the uterus THICKENS, ready for pregnancy. If fertilization does NOT take place, the lining of the uterus is shed in menstrual bleeding and the cycle starts over. The menstrual cycle is under control of multiple hormones secreted by the hypothalamus, pituitary gland, and ovaries. Basically, the hypothalamus produces gonadotropin-releasing hormone, GnRH; the anterior pituitary secretes follicle-stimulating hormone, FSH, and luteinizing hormone, LH; while the ovaries produce estrogen and progesterone. These hormones are involved in a REGULATORY network that results in monthly cyclic changes responsible for follicular maturation and ovulation.
Amenorrhea can be caused by ANATOMICAL or ENDOCRINE problems.
Anatomical causes refer to abnormalities in the female reproductive system and include:
– absent or underdeveloped female organs in some genetic disorders, such as MRKH syndrome
– congenital defects that OBSTRUCT blood outflow
– and destruction of the uterine cavity by previous infections or surgeries.
Endocrine problems refer to structural or functional defects of the hypothalamus, pituitary gland and ovaries. A common cause in this category is the impaired function of the hypothalamus which occurs when the hypothalamic-pituitary-ovarian axis is SUPPRESSED due to an ENERGY DEFICIT. This can result from weight loss, eating disorders, excessive exercise, malabsorption syndromes, or emotional stress. The common feature is a REDUCED production of GnRH by the hypothalamus, which results in corresponding LOW levels of FSH and LH and subsequent impairment of follicular maturation and absence of ovulation.
Other endocrine causes include:
– Kallmann’s syndrome, a genetic disorder associated with congenital defects of the hypothalamus, causing GnRH deficiency.
– Sheehan’s syndrome, a condition in which excessive blood loss during childbirth or chronic hypotension during pregnancy IMPAIRS PITUITARY functions.
– Tumors, infections, trauma or autoimmune destruction of the pituitary gland.
– Polycystic ovary syndrome, an endocrine disorder in which FSH deficiency disrupts follicle maturation.
– Loss of normal ovarian function in conditions such as Turner’s syndrome
– Thyroid disorders
Treatment is by addressing the underlying cause and can range from nutrition plans, hormonal therapy to surgical interventions.
