Last modified on May 22nd, 2020
Amenorrhea (absence of menstrual periods)Amenorrhea is a reflection of some failure in the integrally interconnected neuroendocrine feedback loop between the hypothalamus, the pituitary gland, the ovaries, and the uterus which control the menstrual cycle. However, amenorrhea is not itself a disease.There are two categories of amenorrhea, primary and secondary amenorrhea. Primary amenorrhea is the delay or failure of a young woman to start menstruating upon reaching the age of 16. The course of puberty and the age of menarche vary so widely that there should be no worry until the girl reaches the age of 16, provided that there are other signs of early pubertal changes (growth spurt, underarm or pubic hair, breast development). Treatment for primary amenorrhea usually is not undertaken until the age of 18.Secondary amenorrhea refers to the lack of menstruation that occurs in women who had previously been menstruating but then ceases menstruation for at least three cycles. It is much more common than primary amenorrhea. However, unless symptoms are extreme or there is another underlying problem, such as inability to conceive, there is no pressing need for treatment.Causes of primary amenorrhea may include chromosomal disorders such as Turner’s syndrome (a genetic disorder that prevents sexual maturing in girls); hypothalamic or pituitary diseases; moderate or excessive exercise; dietary deficiencies resulting from disorders such as anorexia nervosa and obesity; extreme physical or psychological stress or a combination of both; and adverse effect of a variety of medication including some tranquilisers and progesterone.The common causes of secondary amenorrhea include many of those listed for primary amenorrhea as well as pregnancy; ovarian cysts and/or tumors; extreme weight loss and/or vigorous physical activity; radiation therapy or an abnormally adherent placenta in a prior pregnancy; and damage to the pituitary.Diagnosis of both types of amenorrhea is usually directed at finding an organic cause, usually by process of elimination. This involves taking a very detailed medical history, followed by a careful physical examination, preferably including a pelvic examination and a skull X-ray to rule out pituitary tumors. Additionally, laboratory tests of urine and vaginal smears may be necessary for secondary amenorrhea.Treatment of amenorrhea is determined by its cause. Hormone therapy can be effective for primary amenorrhea caused by hormonal changes. Surgery can sometimes alleviate cases related to hereditary problems. For secondary amenorrhea, sometimes lifestyle changes can help if weight, stress, or physical activity is causing the amenorrhea. Other times medications and oral contraceptives can help the problem.
Dysmenorrhea (painful menstruation)
Anovulatory bleeding (dysfunctional uterine bleeding)Anovulatory bleeding refers to any abnormal bleeding from the vagina that cannot be considered as part of the normal menstruation cycle. This occurs most often in the first two or three years following menarche and again in the five or so years preceding menopause.Without ovulation in the normal course of the menstrual cycle, no progesterone is produced. The extra endometrial tissue built up during the follicular phase is eventually shed, but not at the regular rate and time that it would have occurred in the instance of ovulation. Progesterone regulates the timing of the menstrual cycle, and without it menstruation becomes irregular or may cease altogether, or it may involve heavy, long-lasting menstrual periods.Experts believe that 20% of ovulation failures are the result of excessive heavy physical exercises, obesity, chronic illness, excess androgen production, thyroid gland dysfunction, excess prolactin production or psychologically seated sexual problems and anxieties. The administration of oral progesterone often will stop heavy bleeding but cannot reinstate ovulation.
Menorrhagia (Heavy Periods)
Metrorrhagia (Irregular/Spotty Bleeding)This refers to bleeding from the vagina between regular menstrual cycles. Some women also have spotting following sexual intercourse. Such bleeding may come from some abnormality of the cervix (possibly a cancer); a polyp on the cervix; or a cervical erosion. Treatment is often unnecessary, but erosions are easily treated by cauterisation. Polyps require removal.Other disorders associated with the menstrual cycle include the following:
Oligomenorrhea (prolonged intervals between menses)Most women of reproductive age menstruate every 25 to 30 days if they are not pregnant, nursing a child, or experiencing other disorders such as tumors, or anorexia nervosa. In oligomenorrhea, menstruation occurs with intervals of 35 or more days between menstrual periods. It is particularly common at menarche during the first few years of menstruation and during perimenopause. The cause of the disorder may be occasional emotional problems, crash diets and obesity, hormonal, or structural in nature.
Polymenorrhea (frequent interval between menses)This is characterized with frequent menstrual periods, with intervals of fewer than 20 days between menstrual flows. It may also be caused by a uterine fibroid. It usually signifies a hormone imbalance, that is, too much estrogen in the absence of progesterone (or relative to progesterone), a condition found mostly in young girls who are not yet ovulating and in women approaching menopause. Some women routinely menstruate every 19 or 20 days and, in the absence of anaemia or other problems, such a short menstrual cycle is no cause for alarm or for treatment.
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