WEDNESDAY MATERNAL HEALTH: AMENORRHEA- Causes, symtopms and treatment

Amenorrhea Overview

Amenorrhea is the absence of menstrual bleeding and may be primary or secondary.

• Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years.
• Secondary amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for three or more months in the absence of pregnancy, lactation (the ability to breastfeed), cycle suppression with systemic hormonal contraceptive (birth control) pills, or menopause.

For a woman to have regular menstrual cycles, her hypothalamus, pituitary gland, ovaries, and uterus should all be functioning normally. The hypothalamus stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH cause the ovaries to produce the hormones estrogen and progesterone. Estrogen and progesterone are responsible for the cyclical changes in the endometrium (uterine lining), including menstruation. In addition, a woman’s genital tract should be free of any abnormalities to allow the passage of menstrual blood

Amenorrhea Causes

Amenorrhea can result because of an abnormality in the hypothalamic-pituitary-ovarian axis, anatomical abnormalities of the genital tract, or functional causes.
Hypothalamic causes

• Craniopharyngioma (a brain tumor near the pituitary gland)
• Teratoma (a tumor made up of a mixture of tissues)
• Sarcoidosis (a chronic disease of unknown cause characterized by the formation of nodules in different parts of the body)
• Kallmann syndrome (deficiency of gonadotropins, which are hormones capable of promoting growth and function of reproductive organs)
• Nutritional deficiency
• Low body weight or growth delay

Pituitary causes

• Prolactinemia (high blood levels of prolactin, a hormone that stimulates secretion of milk from the breasts during breastfeeding) - possibly caused by prolactinoma (a tumor of the pituitary gland secreting the hormone prolactin)
• Other pituitary tumors (for example, Cushing syndrome, acromegaly, or thyroid-stimulating hormone)
• Postpartum pituitary necrosis (death of pituitary cells after a woman delivers a baby)
• Autoimmune hypophysitis (cells of the pituitary gland destroyed by the body’s own defense system)
• Pituitary radiation
• Sarcoidosis

Ovarian causes

• Anovulation (lack of the release of an egg)
• Hyperandrogenemia (high blood levels of male hormones)
• Polycystic ovary syndrome (hormonal disorder affecting women of reproductive age)
• Premature ovarian failure
• Turner syndrome (a genetic disorder characterized by underdeveloped ovaries, absence of menstrual onset, and short stature)
• Pure gonadal dysgenesis (defective development of the ovary)
• Autoimmune oophoritis (cells of the ovaries destroyed by the body’s own defense system)
• Fragile X premutation
• Radiation or chemotherapy
• galactose (an inherited disorder in which galactose, a type of sugar, accumulates in the blood)
• Anatomical abnormalities of the genital tract
• Intrauterine adhesions (the opposing surfaces of the uterine cavity stick together)
• Imperforate hymen (a hymen in which there is no opening, the membrane completely closes off the vagina)
• Transverse vaginal septum (a dividing wall or membrane in the vagina)
• Aplasia (absence of an organ or tissue) of the vagina, the cervix, or the uterus

Functional causes

• Anorexia/bulimia
• Chronic diseases (for example, tuberculosis)
• Excessive weight gain or weight loss
• Malnutrition
• Depression or other psychiatric disorders
• Recreational drug abuse
• Psychotropic drug use (drugs prescribed to stabilize or improve mood, mental status, or behavior)
• Excessive stress
• Excessive exercise

Cycle suppression with systemic hormonal contraceptive (birth control) pills

Amenorrhea Symptoms

Amenorrhea is a symptom of an underlying disorder rather than a condition in and of itself. Additional symptoms may be present depending on the associated condition.

• Galactorrhea (breasts produce milk in a woman who is not pregnant or breastfeeding), headache, or reduced peripheral vision could be a sign of an intracranial tumor.
• Increased hair growth in a male pattern (hirsutism) may be caused by excess androgen (a hormone that encourages development of male sex characteristics).
• Vaginal dryness, hot flashes, night sweats, or disordered sleep may be a sign of ovarian insufficiency or premature ovarian failure.
• Noticeable weight gain or weight loss may be present.

Excessive anxiety may be present in women with associated psychiatric abnormalities.

Amenorrhea Treatment

• In some women, nutritional deficiencies induced by dieting can cause amenorrhea. Such women should eat a properly balanced diet.
• In some women, excessive body weight could be the cause of amenorrhea. These women should restrict the amount of fat in their diet, and they should exercise moderately to maintain an ideal body weight.
• More than 8 hours of vigorous exercise a week may cause amenorrhea. A moderate exercise program may restore normal menstruation.
• In women with anorexia nervosa or excessive weight loss, normal menstrual cycles can often be restored by undergoing treatment to restore and maintain a healthy body weight.
• If amenorrhea is caused by emotional stress, finding ways to deal with stress and conflicts may help.
• Maintaining a healthy lifestyle by avoiding alcohol consumption and cigarette smoking is also helpful

QUOTE OF THE DAY

Either you run the day, or the day runs you. – Jim Rohn

DID YOU KNOW?

• Our blood is on a 60,000-mile journey per day. 
• Our eyes can distinguish up to ten million colour surfaces and take in more information than the largest telescope known to man. 
• Our lungs inhale over two million litres of air every day, without even thinking. Their surface area is large enough to cover one side of a tennis court.