amenorrhea

Amenorrhea: Absence of Menstruation

Amenorrhea refers to the absence of menstruation, often defined as missing one or more menstrual periods [1]. This condition can be primary or secondary, and may be a sign of an underlying medical issue that requires treatment from a healthcare provider [2].

Symptoms of Amenorrhea

The main symptom of amenorrhea is the absence of a period. Other associated symptoms can include:

• Excess facial hair
• Hair loss
• Headache
• Lack of breast development
• And other signs of hormonal imbalance [3]

Types of Amenorrhea

There are two types of amenorrhea: primary and secondary.

• Primary amenorrhea is when a girl has not yet started her monthly periods by the age of 15 years, despite having normal growth and secondary sexual characteristics [4].
• Secondary amenorrhea is when a woman who previously had regular periods stops getting them for more than three months [5].

Causes and Significance

Amenorrhea can be caused by various factors, including chromosomal irregularities, hormonal imbalances, and other medical conditions. It often signifies a larger health problem or condition that needs attention from a healthcare provider [6]. Having regular periods is an important sign of overall health, and amenorrhea should not be ignored.

Definition

Amenorrhea is defined as the absence of a woman's monthly menstrual period [7].

References:

[1] Context result 1 [2] Context result 2 [3] Context result 3 [4] Context result 5 [5] Context result 6 [6] Context result 8 [7] Context result 9

Amenorrhea: Signs and Symptoms

Amenorrhea, or the absence of menstruation, can manifest in various ways. Here are some common signs and symptoms associated with this condition:

• Missing a period: The main sign of amenorrhea is missing a menstrual period for more than 3 cycles [7].
• Excess facial hair: Some women may experience increased body hair growth (hirsutism) due to hormonal imbalances [2, 5].
• Hair loss: Amenorrhea can be accompanied by hair loss, particularly on the scalp [3, 6].
• Headache: Headaches are a common symptom of amenorrhea, often caused by hormonal fluctuations [1, 4, 6].
• Vision changes: Some women may experience vision changes or blurred vision due to hormonal imbalances [1, 6].
• Nausea and pelvic pain: Amenorrhea can also be accompanied by nausea and lower abdominal pain, cramps, or spasms [9].
• Breast development issues: In some cases, amenorrhea may be associated with lack of breast development or changes in breast size [3, 6].

It's essential to consult a healthcare provider if you experience any of these symptoms, as they can indicate an underlying hormonal imbalance or other medical conditions.

References:

[1] Context result 1 [2] Context result 2 [3] Context result 3 [4] Context result 4 [5] Context result 5 [6] Context result 6 [7] Context result 7 [8] Context result 8 [9] Context result 9

Diagnostic Tests for Amenorrhea

Amenorrhea, or the absence of menstrual periods, can be caused by various factors, including hormonal imbalances, anatomical abnormalities, and systemic diseases. To diagnose the underlying cause of amenorrhea, several diagnostic tests may be performed.

• Pregnancy Test: A pregnancy test is usually the first step in diagnosing amenorrhea, as it can rule out pregnancy as a cause (1).
• Blood Tests: Blood tests are used to check hormone levels and detect thyroid or adrenal gland disorders. These tests include:
  • Thyroid function test
  • Ovary function test
  • Androgen test
  • Hormone challenge test
  • Screening for a premutation of fragile X syndrome (2)
• Genetic Testing: Genetic testing may be performed if there is a family history of amenorrhea or other related conditions (3).
• Pelvic Exam: A pelvic exam may be performed to check for any problems with the reproductive organs (4).
• Imaging Tests: Imaging tests, such as ultrasound, may be used to evaluate the reproductive organs and detect any anatomical abnormalities (5).

Initial Workup

The initial workup of primary and secondary amenorrhea includes a pregnancy test and serum levels of luteinizing hormone, follicle-stimulating hormone, and prolactin (6). A complete blood cell count, urinalysis, and serum chemistries should also be evaluated to help rule out systemic disease (7).

Laboratory Examination

Laboratory examination of a blood sample is useful in the diagnosis of amenorrhea, as it can help to understand any hormonal imbalances that may be present. The laboratory tests include: + Serum prolactin + FSH (Follicle-Stimulating Hormone) + LH (Luteinizing Hormone) + TSH (Thyroid-Stimulating Hormone)

Assessment of Estrogen Status

The assessment of estrogen status is an important part of the diagnostic workup for amenorrhea. This can be done through various tests, including: + High serum androgens + Normal serum androgens

References:

(1) [1] (2) [2] (3) [3] (4) [4] (5) [5] (6) [6] (7) [7]

Treatment Options for Amenorrhea

Amenorrhea, or the absence of menstruation, can be caused by various factors, including hormonal imbalances, thyroid disorders, and structural blockages. Drug treatment is often recommended to address these underlying issues.

• Hormone Replacement Therapy (HRT): For primary amenorrhea due to estrogen deficiency, hormone therapy consisting of an estrogen and a progestin is recommended [1].
• Medications for Thyroid and Pituitary Disorders: Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a tumor or structural blockage is causing the problem, surgical intervention may be necessary [3].
• Clomiphene Citrate: In patients with secondary amenorrhea due to PCOS who desire pregnancy, medications such as clomiphene citrate may be prescribed to help trigger ovulation [5].
• Dopamine Agonists: Dopamine agonists are effective in treating hyperprolactinemia, which can cause amenorrhea. In most cases, this treatment restores normal ovarian endocrine function and promotes menstrual regularity [8].

Medications Used to Treat Amenorrhea

Some medications commonly used to treat amenorrhea include:

• Norethindrone systemic (Gallifrey)
• Clomiphene citrate
• Metformin
• Cyclical use of progestins

These medications can help regulate menstrual periods and address underlying hormonal imbalances. However, the specific treatment plan will depend on the individual's medical history and the cause of their amenorrhea.

References

[1] Apr 12, 2024 — For primary amenorrhea, hormone therapy, consisting of an estrogen and a progestin, is recommended for women with estrogen deficiency. [3] Feb 9, 2023 — Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a tumor or structural blockage is causing the problem, ... [5] In patients with secondary amenorrhea due to PCOS who desire pregnancy, medications such as clomiphene citrate, may be prescribed to help trigger ovulation. [8] Jun 21, 2024 — Polycystic ovary syndrome. Multiple medical treatments can help regulate menstrual periods. These include metformin, clomiphene and cyclical use ...

Differential Diagnoses for Amenorrhea

Amenorrhea, or the absence of menstruation, can be caused by a variety of factors. When evaluating secondary amenorrhea, it's essential to consider several differential diagnoses.

• Physiologic causes: These include conditions such as polycystic ovary syndrome (PCOS), hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency [2].
• Outflow tract abnormalities: This category includes conditions like vaginal agenesis, androgen insensitivity syndrome, Turner syndrome (45,X), and mosaicism [1].
• Primary ovarian insufficiency: Also known as premature ovarian failure, this condition occurs when the ovaries stop functioning before the age of 40 [5].
• Hypothalamic or pituitary disorders: These can include conditions like hyperprolactinemia, which is characterized by high levels of prolactin in the blood [2].
• Constitutional delay: This refers to a condition where puberty is delayed due to genetic factors [8].

It's worth noting that primary amenorrhea has its own set of differential diagnoses, including vaginal agenesis, androgen insensitivity syndrome, Turner syndrome (45,X), and mosaicism [1].