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Diseases & ConditionsSexual Health

What is Amenorrhea?

What is Amenorrhea? Amenorrhea is the absence of menstrual bleeding, or if it is stopped for any reason after the menstrual period starts. The most common cause is pregnancy. The other cause of amenorrhea is related to reproductive organs or glands that regulate hormone levels. Pregnancy, breastfeeding and menopause, intensive exercise, being too skinny, physical illness, and stress can cause amenorrhea. Amenorrhea is a symptom, not a disease in itself and can be prevented by the diagnosis of the underlying cause. Its causes and treatments depend on the type of amenorrhea. This text will explain the types of amenorrhea, its symptoms, causes, and treatment below.

What is Amenorrhea?

Amenorrhea is the absence of menstruation and divided into two: primary amenorrhea and secondary amenorrhea. Primary amenorrhea occurs in girls who cannot menstruate until the age of 16 and do not have any changes in their physical appearances like breast development and growing body hair. Secondary amenorrhea is the case in women who have previously menstruated but missed three consecutive periods. Pregnancy, breastfeeding, birth control pills, or menopause can stop menstruation. Amenorrhea may be caused by ovaries, pituitary gland, hypothalamus, or uterus disorders. Longer-term amenorrhea may indicate a disease or a chronic condition. Treatment of the diagnosed disease removes amenorrhea. Infertility and possible bone resorption are side effects.

Symptoms of Amenorrhea

Symptoms of Amenorrhea
Symptoms of Amenorrhea

The first and main symptom of amenorrhea is the absence of menstruation.

  • Breast and nipple discharge
  • Hair loss, headache
  • Pelvic pain
  • Hirsutism (excessive hair)
  • Acne
  • Unexplained weight loss or gain
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What Causes Amenorrhea?

  • Natural causes such as pregnancy, breastfeeding or menopause
  • Use of birth control pills
  • Anovulation
  • Wounds in the uterus, lack of reproductive organs
  • Antidepressant, radiation, chemotherapy, blood pressure and drugs to treat allergy
  • Depression, psychiatric disorders
  • Stress and anxiety
  • Being too skinny and overweight
  • Eating disorders such as anorexia or bulimia
  • Sports such as ballet and athletics
  • Genetic factors
  • Polycystic ovary syndrome (PCOS)
  • Asherman’s syndrome
  • Chronic diseases

Causes of Primary Amenorrhea

Primary amenorrhea is the result of a genetic or anatomical condition in young women that do not develop menstruation until age 16. Many genetic conditions are those in which the feminine organs do not normally occur in the womb or function properly.

  • Hypothalamus
  • Gonadal dysgenesis
  • Disorders of steroid sex hormones such as estrogen, androgen, and progesterone
  • Polycystic ovary syndrome
  • Galactosemia (an inherited disorder in which galactose accumulates in the blood)
  • Turner syndrome: Genetic disorder characterized by underdeveloped ovaries.
  • Hymen problems
  • The vagina, cervix or uterus do not naturally occur
  • Cushing’s syndrome
  • Kallmann syndrome

Causes of Secondary Amenorrhea

Pregnancy is the most common cause

  • Menopause, Breastfeeding
  • Pituitary gland tumors, overactive thyroid gland, low estrogen, high testosterone
  • Some medical treatments, chemotherapy, radiotherapy, and antipsychotic drugs
  • High levels of androgens: increase in testosterone
  • Ovarian causes: Polycystic ovary syndrome, early menopause
  • Lifestyle factors: Overweight or underweight women,
  • Emotional stress, depression
  • Causes of the uterus: intrauterine adhesion
  • Malnutrition, anorexia

Hypophysis origin:

  • Sheehan syndrome, hyperprolactinemia
  • Diabetes, hypothyroidism, hyperthyroidism
  • Diseases like Addison’s disease Sarcoidosis and Cirrhosis
  • Cushing’s syndrome
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Diagnosis of Amenorrhea

Diagnosis of Amenorrhea
Diagnosis of Amenorrhea

Treatment of primary and secondary amenorrhea is determined by a specific cause. Once the cause has been identified, treatment of the disease is applied. Treatment is performed to alleviate the symptoms of hormonal imbalance, to menstruate, to prevent complications, or to maintain fertility. Here, patient history and secondary sexual characteristics are very important to determine the cause of amenorrhea. After physical and gynecological examination, blood tests are performed to determine the levels of ovarian, pituitary, and thyroid hormones. Ultrasonography, X-ray, CT, or MRI scanning may help in determining the cause of amenorrhea and in the diagnosis of abnormalities of the genital system. The first test for some individuals is the pregnancy test. 

Amenorrhea Treatment

Amenorrhea treatment with medication

  • Treatment with dopamine agonists restores ovulation functions.
  • In premature ovarian failure, hormone replacement therapy may be recommended.
  • Metformin is widely used in polycystic ovary syndrome to improve ovulation
  • Oral contraceptives are used to prevent pregnancy and improve the menstrual cycle
  • Assisted reproduction methods and gonadotropin drugs

Amenorrhea treatment with surgery

  • Some pituitary and hypothalamic tumors may require surgery and radiation therapy.
  • In women with intrauterine adhesions, it may be necessary to remove damaged tissue
  • Surgery may be recommended in cases caused by genetic or anatomical abnormalities.
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