Absence of menstrual period

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Amenorrhea simply refers to the absence of menstrual periods. It is the medical term for the absence of menstrual periods, either temporarily or permanently. It can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.

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Amenorrhea is a normal feature in pre-pubertal, pregnant, and postmenopausal females. In females of reproductive age, diagnosing amenorrhea is a matter of first determining whether pregnancy is the etiology. In the absence of pregnancy, the challenge is to determine the exact cause of absent menses.

The menstrual cycle can be influenced by many internal factors such as transient changes in hormonal levels, stress and illness, as well as external or environmental factors. Missing one menstrual period is rarely a sign of a serious problem or an underlying medical condition, but amenorrhea of longer duration may signal the presence of a disease or chronic condition. Amenorrhea is a symptom and not a disease in itself, so amenorrhea can be prevented only to the extent that the underlying cause can be prevented.
Causes of amenorrhea
The normal menstrual cycle occurs because of changing levels of hormones made and secreted by the ovaries. Disorders that affect any component of this regulatory cycle can lead to amenorrhea. The causes are classified into primary and secondary.

Primary amenorrhea
Primary amenorrhea is mostly the result of a genetic or anatomic condition in young females that never develop menstrual periods (by age 16) and is not pregnant. Many genetic conditions that are characterized by amenorrhea are circumstances in which some or all of the normal internal female organs either fail to form normally during fetal development or fail to function properly.
Diseases of the pituitary gland and hypothalamus can also cause primary amenorrhea since these areas play a critical role in the regulation of ovarian hormones.Gonadal dysgenesis, a condition in which the ovaries are prematurely depleted of follicles and oocytes (egg cells), leads to premature failure of the ovaries.Turner syndrome in which women are lacking all or part of one of the two X chromosomes normally present in the female.Androgen insensitivity (in which individuals have XY (male) chromosomes but do not develop the external characteristics of males due to a lack of response to testosterone and its effects)Congenital adrenal hyperplasia and polycystic ovary syndrome (PCOS ) are inclusive.

Secondary amenorrhea

Pregnancy is an obvious cause of amenorrhea and is the most common reason for secondary amenorrhea. Further causes are varied and may include conditions that affect the ovaries, uterus, hypothalamus, or pituitary gland.
Hypothalamic amenorrhea is due to a disruption in the regulator hormones produced by the hypothalamus in the brain. A number of conditions can affect the hypothalamus: extreme weight loss, emotional or physical stress, rigorous exercise and severe illness.
Other types of medical conditions can cause secondary amenorrhea:
Tumors or other diseases of the pituitary gland that lead to elevated levels of the hormone prolactin (which is involved in milk production) also cause amenorrhea due to the elevated prolactin levels.
hypothyroidism; elevated levels of androgens (male hormones), either from outside sources or from disorders that cause the body to produce too high levels of male hormones;
ovarian failure (premature ovarian failure or early menopause);
polycystic ovary syndrome (PCOS)
Asherman’s syndrome, a uterine disease that results from scarring of the uterine lining following instrumentation (such as dilation and curettage) of the uterine cavity to manage postpartum bleeding or infection.

Treatments may include surgical correction of anatomical abnormalities, medications or hormone therapies, and treatment of any underlying conditions responsible for amenorrhea.


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