Lack of Menstruation (Amenorrhea)

Lack of menstruation or Amenorrhea is divided into two groups:Primary and Secondary Amenorrhoea.

If a girl has not show any symptoms of breast or body hair development or menstruated despite being 14 years old, primary amenorrhoea is considered.However, if there are signs of breast or body hair development, the diagnosis age for amenorrhoea is 16.Secondary amenorrhoea is when a female who had menstruated in the past has a sudden lack of menstruation.

Potential “pregnancy” should not be skipped in case of not menstruating.This applies to all individuals, children and women alike.

The hypothalamus (located underneath the thalamus and is the forebrain region which makes up the foundation of the third ventricle), pituitary, ovary and uterus (womb) work as normal in woman who menstruate regularly.Hypothalamus and pituitary located in the brain, stimulate the ovaries through FSH and LH hormones. Stimulated ovaries produce oestrogen and progsterone hormones.Oestrogen and progsterone hormones stimulate the inner layer of the womb, endometrium, and cause menstrual bleeding.A consecutive mechanism is necessary to have menstrual bleeding normally and regularly every month.If the mechanism is broken at any stage, lack of menstruation or menstrual Irregularity occurs.The paths of bleeding (womb opening, vagina, hymen) must not be obstructed to achieve menstrual bleeding, as well as this mechanism.

Causes of Primary amenorrhoea:

– Pathologies related to Hypothalamus and pituitary, tumours

– Imperforated Hymen (No gap in hymen)

– Turner Syndrome

– Structural Development Delay

– Galactosemia

– Imperforated Hymen (No gap in hymen)

– Transverse Vaginal Septum (Veil in vagina)

– Vagina, cervix (womb opening) or congenitally underdeveloped womb

Causes of Secondary amenorrhoea:

– Physiologic:Pregnancy, corpus luteum cyst, breast feeding, menopause

– Hypothalamus

– Pressure on pituitary axe

– Amenorrhoea after use of birth control pills

– Stress, depression

– Weight loss, emaciation, insuffiicient nourishment

– Pituitary disease:Ablation of pituitary (removing), Sheehan Syndrome,

– Prolactinoma (hyperprolactinaemia, over lactation)

– Uncontrolled endocrinopathies:Diabetes, hypothyrodism and hyperthyrodism

– Polycystic ovary disease

– Chemotherapy

– Radiotherapy

– Endometrial Ablation (surgical removal of inner womb tissue)

– Clinging in the womb (Asherman Syndrome)

– Medical treatment:Systemic steroids, Danazol, GnRh Analogs

– Premature ovarian failure, early menopause

– Sarcoidosis

– Hyperandrogenemia (Increasing of male hormones like testosterone)

Amenorrhoea Diagnosis:
The best method for diagnosis is FSH, LH, Prolactin, thyroid hormones depending on situation, ultrasonography.If there is suspicion of a pathology inside the brain CT or MR might be required.In some cases HSG (hysterosalpingography), SIS (Salin infusion sonography) or observing inside the womb via hysterescopy may be required.