What is amenorrhea? Amenorrhea is a condition in which women who should have menstruation but not menstruation. Normal menstrual cycles occur because of changes in hormone levels. Female reproductive hormones are produced by the ovaries.
The ovary responds to hormonal signals from the pituitary gland located at the base of the brain, which is also controlled by hormones produced in the hypothalamus of the brain. Disorders that affect each component of the hormonal cycle can cause amenorrhoea.
The common cause of amenorrhea in young women is often misunderstood as an undiagnosed pregnancy. Clinically, a 13-year-old woman who has not experienced signs of puberty such as breast growth and menstruation, is recommended to see a doctor. Similarly, women who have menstruated, but did not get their period within 90 days from the last menstruation.
Amenorrhea itself is divided into two, namely:
1. Primary amenorrhea
Primary amenorrhea is usually the result of a genetic or anatomic condition in young women who have never had a menstrual period at all (even though they are 16 years old) and are not pregnant. Those who experience amenorrhea, their internal reproductive organs do not form normally.
Pituitary gland (pituitary) and hypotaalamus (brain regions that are important for the control of hormone production) can also cause primary amenorrhea because this region plays an important role in the regulation of ovarian hormones.
Other conditions that may cause primary amenorrhea are androgen insensitivity (where the individual has an XY chromosome that is genetically male but does not show male physical characteristics due to a lack of response to testosterone), congenital adrenal hyperplasia, and polycystic ovary syndrome (PCOS).
1. Secondary amenorrhea
Secondary amenorrhea is a condition in which the patient has menstruated normally before, then the cycle stops. Pregnancy is a major cause of this type of amenorrhoea.
Meanwhile, amenorrhea caused by problems in the hypothalamus, causes disruption in hormone regulation which later affects the pituitary gland, which then sends signals to the ovaries to produce the hormones estrogen and progesterone so that a woman gets her period.
A number of conditions can affect the hypothalamus including:
- Extreme weight loss
- Emotional or physical stress
- Rigorous training
- Chronic disease.
Causes of Amenorrhea
The cause of amenorrhea is caused by many things. Some things include:
- Treatment of chronic diseases
- Removal of the uterine bladder
- Congenital abnormalities in the pregnancy system
- Chromosomal abnormalities
- Excessive exercise
- Non-growth of uterine and vaginal organs (uterovaginal agenesis)
- Disorders of the central nervous system
- Puberty late
- Disorders of the ovaries (ovarian), such as ovarian tumors, ovarian failure
- Impaired hormone production, such as hypotioridism, cushing’s syndrome
- Severe diseases, such as chronic kidney disease.
Symptoms of Amenorrhea
The main sign of amenorrhea is the absence of menstrual periods. Depending on the cause of amenorrhea, you may experience other signs or symptoms along with the absence of periods, such as:
- Fluid in the breast putin
- Hair loss
- Vision loss
- Excess facial hair
- Pelvic pain
Diagnosis of Amenorrhea
To check for amenorrhoea, a complete medical history is needed. Usually the doctor will advise to do a blood test to check the levels of ovarian, pituitary, and thyroid hormones.
This test may include the measurement of prolactin, follicle-stimulating hormone (FSH), estrogen, thyrotropin, dehydroepiandrosterone sulfate (DHEA-S), and testosterone. For some individuals, a pregnancy test is the first test done.
Further tests that are usually done are imaging tests, such as ultrasound, x-rays, as well as CT-Scan or MRI scan to help determine the cause of amenorrhea.
The treatment carried out depends on the cause of amenorrhea. Some treatment methods suggested by doctors according to the cause of amenorrhea, for example:
- Estrogen hormone replacement therapy (estrogen replacement therapy/ ERT) which helps stabilize the hormone to trigger the menstrual cycle, in the condition of primary ovarian insufficiency. ERT will replace estrogen that is not produced by the ovaries to regulate the menstrual cycle normally. The doctor will also give progestin or progesterone to reduce the risk of uterine cancer
- For treatment of women who have polycystic ovary syndrome (PCOS), treatment will focus on reducing androgen hormone levels
- Use of contraceptive pills or hormonal drugs that trigger menstrual cycles
- Amenorrhea caused by lifestyle factors can be managed by maintaining ideal body weight, controlling stress, and setting a proper and regular exercise schedule
Impact of Amenorrhea on Women
Infertility (infertility) is a bad impact that can be experienced by women. In addition, amenorrhea also causes osteopenia (decreased bone density) or osteoporosis, where this occurs due to low estrogen levels and causes amenorrhea that is disordered.