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AMENORRHEA

Amenorrhea

Primary amenorrhea is the absence of the menstrual period by the age of 16. Treatment of amenorrhea may range from hormonal supplementation for developmental abnormalities of the reproductive system to surgery for tumors of the pituitary.

Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period.

Most girls begin menstruating between ages 9 and 18, with an average around 12 years old. Primary amenorrhea is not considered to have occurred until a girl is beyond age 16, if she has undergone other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.

COMMON CAUSES OF PRIMARY AMENORRHEA:

  • Failure of the ovaries (the ovaries hold the eggs)
  • Problems in the pituitary gland (produces a hormone involved in menstruation)
  • Poorly formed reproductive organs
  • Many times, the cause of primary amenorrhea is unknown.
  • COMMON CAUSES OF SECONDARY AMENORRHEA:

    • Birth control methods, such as Depo Provera
    • Breast feeding
    • Certain drugs
    • Depression
    • Extreme weight loss
    • Menopause
    • Ongoing illness
    • Over-exercising
    • Poor nutrition
    • Pregnancy
    • Problems with hormone-making glands
    • Stopping the use of birth control pills
    • Stress
    • Sudden weight gain or being very overweight (obesity)
    • Tumors on the ovaries (rare)

    OTHER CAUSES OF AMENORRHEA:

    Amenorrhea can be caused by any number of changes in the organs, glands, and hormones involved in menstruation.

    • Adrenogenital syndrome
    • Chromosomal abnormalities such as Turner's syndrome (XO) or Sawyer's syndrome (XY)
    • Chronic (long term) illnesses
    • Congenital heart disease (cyanotic)
    • Congenital adrenal hyperplasia
    • Craniopharyngioma, pituitary tumors, ovarian tumors, adrenal tumors
    • Cushing's disease
    • Cystic fibrosis
    • Drastic weight reduction (from poverty, fad dieting, anorexia nervosa, bulimia, very strenuous exercise, or other cause)
    • Extreme obesity
    • Genital abnormalities present since birth (absence of the uterus or vagina, vaginal septum, cervical stenosis, imperforate hymen)
    • Gonadal dysgenesis
    • Hyperprolactinemia
    • Hypoglycemia
    • Hypogonadotropic hypogonadism
    • Hypothyroidism and hyperthyroidism
    • Malnutrition
    • Polycystic ovarian disease
    • Prader-Willi syndrome
    • Pregnancy
    • Primary amenorrhea in the United States occurs in less than 0.1% of girls.
    • Testicular feminization
    • True hermaphroditism

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    SIGNS AND TESTS

    • Chromosome analysis
    • FSH
    • Head CT
    • Head MRI scan
    • Laparoscopy
    • LH
    • Physical examination and medical history
    • Progesterone withdrawal
    • Prolactin
    • Serum chemistry (serum gonadotropin)
    • TSH
    • T3 and T4
    • Ultrasound, pelvic region
    • Urine chemistry, 17-ketosteroids
    • Urine pregnancy test

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    TREATMENT

    Treatment depends on the cause of the amenorrhea. Primary amenorrhea caused by developmental abnormalities (which may result when the parts of the female reproductive system did not form properly before birth) may require hormonal supplementation, surgery, or both.

    Pituitary tumors, located in the brain, are usually treated with bromocriptine, a drug that inhibits the abnormally high prolactin secretion caused by these tumors. Surgical removal may also be necessary. Radiation therapy is usually reserved for situations in which other medical or surgical treatment regimens are not successful.

    In any case, support and counseling for the patient and family is necessary. This will address specific concerns and provide guidance regarding anticipated sexual development.

    For women who do not have other reproductive abnormalities, work up for amenorrhea is delayed until after age 16.

    If the condition is caused by systemic disease, treatment of the disease may allow menstruation to begin.

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    THE PROGNOSIS DEPENDS:

    The prognosis is good, depending on the cause of amenorrhea.

    If amenorrhea is caused by one of the following conditions, there is a fairly good possibility of correcting the amenorrhea through lifestyle change, medication or surgery:

    • Adrenogenital syndrome
    • Chronic illness
    • Congenital heart disease (cyanotic)
    • Drastic weight reduction (resulting from poverty or fad dieting)
    • Extreme obesity
    • Hyperthyroidism
    • Hypoglycemia
    • Hypogonadotropic hypogonadism
    • Imperforate hymen
    • Malnutrition
    • Normal delay of onset (up to age 14 or 15)

    [ back to top ]

    If the amenorrhea is caused by one of the following conditions, it is unlikely that the amenorrhea can be corrected by any method:

    • Congenital abnormalities of the genital system
    • Craniopharyngioma
    • Cystic fibrosis
    • Gonadal dysgenesis
    • Prader-Willi syndrome
    • Turner's syndrome (XO)
    • Testicular feminization syndrome
    • True hermaphroditism
    • If the amenorrhea cannot be corrected, sometimes it is possible to create a pseudo-menstruation with medication to help the young woman feel more like menstruating females.

    COMPLICATIONS

    Emotional distress or crisis about being different from other menstruating females.

    CALL YOUR PHYSICIAN IF:

    • You are over age 16 haven't had your first period
    • You miss a period
    • Have trouble with your balance, coordination, or vision
    • Begin producing breast milk, although you have not given birth
    • Have excessive body hair growth

    TO PREVENT SECONDARY AMENORRHEA:

    • Maintain a healthy lifestyle
    • Stay at a healthy weight
    • Learn ways to cope with stress and emotional problems
    • Get a pelvic exam and Pap test once a year


    DISCLAIMER: **This web site's goal is to provide you with information that may be useful in attaining optimal health. Nothing in it is meant as a prescription or as medical advice. You should check with your physician before implementing any changes in your exercise or lifestyle habits, especially if you have physical problems or are taking medications of any kind.