Amenorrhea may be normal at certain periods in a woman's life, for example, during
pregnancy, during
breastfeeding, before attaining
puberty and after the
menopause.
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Pathological Amenorrhea (Loss of Periods)
Pathological Amenorrhoea or loss of periods is amenorrhea that occurs as a symptom of an underlying disease. It is not a disease process in itself. There are two types of pathological amenorrhea.
- Primary amenorrhoea : When a girl has never experienced menarche and menses, she is said to be suffering from primary amenorrhoea or primary lack of menses. The cause is usually congenital, i.e. from birth, and can be due to genetic or chromosomal abnormalities or due to a defect in the development of the reproductive tract. Treatment of this condition is very difficult.
- Secondary amenorrhoea : When the patient has had at least one episode of spontaneous menses before the loss of her periods, she is said to suffer from secondary amenorrhoea. This is the commonest form of amenorrhoea. The problem may lie in the hypothalamus and the pituitary, or the uterus or the ovary. Other endocrine glands like the thyroid, the pancreas and the adrenal cortex also have a role to play in causing amenorrhoea.
Hypothalamic Secondary Amenorrhoea
The Hypothalamus is a kidney-shaped structure in the mid-brain which is influenced by emotional responses. It is believed that stimulation for hormonal release originates in the hypothalamus. Dysfunction in the hypothalamus can cause amenorrhoea.
Causes :
- Diseases in the midbrain : like encephalitis, meningitis, tumours.
- Influences from the cerebral cortex :
- Psychoses like depressive mental disorders often cause loss of menses. It can also be caused by electric convulsion therapy given as treatment for some types of mental disorders.
- Emotional upsets like the death of a close friend or a relative, change of work or residence, traveling and marriage can temporarily cause amenorrhoea.
- Pseudocyesis or false pregnancy is a condition in which a woman believes that she is pregnant and subconsciously suppresses her menstruation. She can also develop other signs of pregnancy like nausea and vomiting, an increase in body weight, breast changes and swelling of the abdomen. Read more...
- Anorexia Nervosa is a syndrome resulting from a girl’s skewed image of her own body image. The girl refuses to eat, causing severe weight loss and amenorrhea besides a number of other symptoms. Read more...
- Post pill Amenorrhea: Oral Contraceptive pills can also suppress the hypothalamic-pituitary system to cause loss of menses. Read more...
- Pituitary Amenorrhoea : Lack of menses/periods due to a cause in the pituitary gland is very rare. But some of them are:
- Ovarian Amenorrhoea : The cause of amenorrhea in this case lies in the ovaries.
Causes :
- Decreased Production of oestrogens and progesterones : Surgical removal of the ovaries or exposure to radiation (e.g. exposure during X-rays) can decrease the level of these hormones in the body. Less production of oestrogen and progesterone can also be due to abnormal sex chromosomes like 47XXX, 46XX/XO.
- Continuous production of oestrogens and progesterones : This can occur in the presence of certain hormone producing tumours of the ovary, like thecal cell tumours.
- Production of male hormones : Certain ovarian tumours can produce male hormones and can cause amenorrhoea.
- Polycystic Ovarian Syndrome: Also called the Stein-Leventhal Syndrome, the chief complaint of the patient in this condition may be none or irregular periods or very decreased flow of blood during her periods. Infertility or subfertility may also be the presenting complaint. Failure of ovulation because of the thick cortex of the ovary is believed to be the main cause of loss or irregularity of periods. Read more...
- Uterine Causes :
- Congenital absence of uterus
- Surgical removal of the uterus.
- Damage after radiotherapy.
- Asherman's Syndrome: Too heavy curettage after D&C or abortion can cause the two walls of the uterus to get damaged with formation of scar tissue. Growth of the endometrium is thus prevented, causng failure of periods. Read more...
- Other causes :
- Thyroid : Both hypofunction and hyperfunction of the thyroid can cause loss of periods.
- Pancreas : Diabetes mellitus can cause amenorrhoea, especially if the disease starts in childhood.
- Adrenal Cortex : Tumours or hyperplasia of the adrenal cortex can cause amenorrhoea.
- Chronic diseases : Most chronic diseases can cause amenorrhoea. Of these, tuberculosis is the most important as the tuberculous toxins appear to have a special affinity for the ovary and the uterine endometrium.
- Nutritional Causes : Severe starvation as seen in malabsorption syndromes and during war and famine can cause loss of menses. On the other hand, severe obesity due to overeating or any other cause can also cause amenorrhoea.
- Environment : Sudden change in the environment as in change of residence or in occupation can cause amenorrhoea. Stress during examination can also cause loss of menses.
- Severe exercise : as in long distance running can cause amenorrhoea.
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