Absence of Menstrual Periods
Amenorrhoea refers to the absence of menstrual periods. The absence of menstruation may usually be due to an underlying problem with the reproductive system. The most common cause of Amenorrhoea is hormonal disruption.
The production of the female sex hormones namely; Oestrogen and Progesterone may be affected by various factors such as reproductive disorders, weight loss, weight gain, stress or excessive exercise.
Primary and Secondary Amenorrhoea
Amenorrhoea may be categorized into Primary amenorrhoea and Secondary amenorrhoea.
Primary amenorrhoea – In Primary amenorrhoea, menstruation hasn’t started by 14 years and there are no signs of other sexual characteristics such as development of breasts or pubic hair, or in certain other cases, menstruation begin only by 16 years, even though other sexual characteristics may have developed earlier.
Secondary amenorrhoea – Menstruation has stopped for about six months.
The menstrual cycle
The brain structures namely; the hypothalamus and the pituitary gland, play an important role in controlling the entire menstrual cycle. The pituitary gland produces the female sex hormones; Oestrogen and Progesterone which thicken the lining of the uterus to prepare for a possible pregnancy.
However, when a pregnancy doesn’t occur, hormone levels tend to drop and lead to the dislodging of the lining of the uterus. This is known as a period or menstruation. Certain disorders of the hypothalamus, pituitary gland or ovaries can result in disruption in menstruation, causing Amenorrhoea.
Various factors can cause the malfunctioning of the hypothalamus and trigger Amenorrhoea, such as:
- Loss of weight
- Excessive physical exercise
- Certain medications for treating mental health conditions
Amenorrhoea – Other causes
Certain other disorders that can result in Amenorrhoea include:
- Polycystic Ovarian Syndrome – In this condition, clusters of blister-like cysts tend to develop in the ovaries. The typical symptoms include irregular periods and excessive hair growth. Women with polycystic ovarian syndrome are particularly vulnerable to Amenorrhoea if they gain weight.
- Hyperandrogenaemia – Significantly high levels of male sex hormones which can impact the reproductive system. It can also be caused by ovarian or adrenal tumours or certain congenital conditions.
- Hyperprolactinaemia – Significantly high levels of the breastfeeding hormone named Prolactin caused either due to over activity of the pituitary gland or the presence of a tumour in the gland.
- Failure in ovulation -Low levels of Oestrogen may result in the failure in ovulation, which completely stops the menstrual cycle.
- Certain vaginal abnormalities– If the hymen is sealed, it prevents menstrual blood from leaving the vagina. Some of the symptoms of this condition include a swollen abdomen, delayed periods and intense abdominal pain.
Diagnosis of Amenorrhea
The tests for the diagnosis of Amenorrhea include:
- Pregnancy tests
- Physical examination
- Evaluation of Gynaecological history and contraceptive methods used by the patient
- Hormone tests to examine the functioning of the hypothalamus, pituitary glands and ovaries
- CT scans and ultrasound of the reproductive system.
Treatment for Amenorrhea
The treatment for amenorrhoea generally depends on the cause. If the condition is caused by weight loss or excessive exercise, you will be encouraged to maintain a healthier body weight.
Some of the other treatment options may include weight loss if you are overweight and taking measures for the effective management of the underlying disorder. Hormone Replacement Therapy (HRT), such as the combined oral contraceptive pill, will generally cause periods to resume normally, but will not help to treat the underlying cause.