Amenorrhea

Amenorrhea is a condition when a woman does not experience menstruation.

• Primary amenorrhea ➡ this condition occurs when a woman aged 16 years has not experienced menstruation.
• Secondary amenorrhea ➡ if a woman of childbearing age is not pregnant, does not menstruate after 6 months from the last menstrual period.

Clinically, women aged 13 years who have not experienced symptoms of puberty such as breast growth and menstruation, are advised to consult a doctor. Likewise with women who have experienced menstruation, but did not get a period within 90 days from the last menstruation.

The symptoms.

• Headache.
• Breasts do not enlarge.
• Vision loss.
• Excessive facial hair growth.
• Hair loss.
• Sound like a man.
• Zits.
• Discharge of milk even though not breastfeeding, due to increased levels of prolactin.
• Pelvic pain.

Cause.

The main cause of amenorrhea ➡ the ovary does not produce or only slightly produce the sex hormones estrogen and progesterone.

This happens under conditions :

• Gonadotropin releasing hormone (GnRH) deficiency.
• Eating Disorders.
• Failure to thrive.
• Hypopituitarism.
• Prolactin excess hormone.
• Tumor of the brain.
• Congenital adrenal hyperplasia.
• Cushing's Syndrome.
• No formation of uterus, vagina or cervix.
• Androgen insensitivity syndrome.

Causes of secondary amenorrhea ➡ 

• Use of injection contraception.
• Body weight is too low.
• Excessive exercise.
• Stress.
• Hormonal imbalance.
• Tumors of the pituitary gland in the brain.
• Anorexia.
• Prolactin excess hormone.
• Abnormalities in the structure of reproductive organs.
• Primary ovarian insufficiency.
• Ovarian Tumors.
• Cushing's Syndrome.

Diagnosis.

• Patient's medical history.
• Physical examination especially around the pelvis.
• Pregnancy tests on sexually active women.
• Blood test to see hormone levels.
• Ultrasound.
• CT scan.
• MRI to see structural abnormalities in the reproductive organs.

Treatment.

• Reducing androgen hormone levels.
• Use of contraceptive pills or hormonal drugs that trigger menstrual cycles.
• Estrogen replacement therapy / ERT to stabilize the hormones that trigger the menstrual cycle.
• Providing progestin or progesterone to reduce the risk of uterine cancer.
• Maintain ideal body weight.
• Control stress.
• Proper and regular exercise.

Complications.

• Infertility.
• Decreased bone density (osteoporosis).