Amenorrhoea

Specialty of Obstetrics & gynaecology

What is amenorrhoea?

Amenorrhoea is the absence of a menstrual period in a woman of reproductive age. It may be physiological in the following moments of a woman’s life:puberty, menopause, pregnancy and breastfeeding. Other than that, amenorrhoea can be caused by various gynaecological conditions.

Amenorrhoea can be divided into two categories:

  1. Primary amenorrhoea: it can occur in females under 16 who haven’t had their first period yet, but already have other traits of puberty (enlarged breasts and body hair).
  2. Secondary amenorrhoea: the absence of menstruation for three months in women whose menstrual period was never irregular, or for nine months in women who've had oligomenorrhoea (menstrual period being four or more days late) and are not pregnant, breastfeeding or going through menopause.

Prognosis of amenorrhoea:

The prognosis for secondary amenorrhoea largely depends on what causes it. If the underlying cause can be treated, the outlook is generally positive. On the other hand, if the underlying cause cannot be treated or it is a particularly severe condition (womb cancer), the outlook is more negative.

What are the symptoms of amenorrhoea?

Based on the cause of amenorrhoea, some of the symptoms may be:headache, vision disorders, hirsutism (excessive facial hair growth), acne, pelvic pain, vaginal dryness, hair loss, hot flushes, night sweats, sleep disorders, and excessive weight loss or gain.

How is amenorrhoea diagnosed?

To formulate an accurate diagnosis of what is causing amenorrhoea, you may have to do one or more of the following: going through your symptoms, pelvic examination, breasts and genital organs exam, pregnancy test (to confirm or exclude a potential pregnancy), FSH, LH, TSH and prolactin hormone levels, pelvic ultrasound (to see if there’s any anatomical anomalies), CT scan and/or head MRI scan (to determine whether or not there is a tumour of the hypothalamus or of the pituitary gland), hysteroscopy or hysterosalpingography (in case the pelvic examination and pelvic ultrasound are not enough).

What causes amenorrhoea?

There are many potential causes for amenorrhoea, which can be associated with:

  • Natural causes: pregnancy, breastfeeding and menopause;
  • Being on (any kind of) birth control;
  • Taking certain medications, such as antipsychotics, chemotherapeutic agents, antidepressants, blood pressure control medications and allergies control medications;
  • Weight loss associated with anorexia nervosa or bulimia;
  • Morbid obesity;
  • Over training;
  • Stress;
  • Illegal drug abuse;
  • Hormone imbalances caused by a tumour of the hypothalamus or of the pituitary gland, malnutrition, PCOS, thyroid conditions, or Cushing’s syndrome.
  • Anatomical anomalies of the reproductive system: uterine scarring or intrauterine adhesions, partial or total removal of the uterus, malformations of the vagina;
  • Radiotherapy;
  • Depression and other psychiatric disorders;

How can amenorrhoea be prevented?

Amenorrhoea can only be prevented if what causes it can be kept under control or prevented, such as anorexia nervosa, overtraining, malnutrition, stress or obesity.

How can amenorrhoea be treated?

Possible treatments include:

  • Eating a certain diet, either to reach a normal weight (if you are suffering from anorexia nervosa or bulimia) or to lose weight;
  • If the underlying cause is overtraining, decreasing your exercise routine;
  • Going off the medications which may be causing the amenorrhoea;
  • Surgery, if it is caused by pituitary tumours, intrauterine adhesions and genital tract anomalies;
  • Pharmacotherapy, if the amenorrhoea is caused by PCOS.

Which doctor should I talk to?

To accurately diagnose and treat amenorrhoea, you will have to see a specialised gynaecologist.

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