Amenorrhea is the absence of menstruation. There are two categories of this disorder. Primary amenorrhea is the failure to begin menstruating by the age of 16. Secondary amenorrhea, the more common of the two conditions, is the absence of three or more periods in a row in a woman who has been menstruating for some time. Primary amenorrhea is specifically defined at the age of 16 and can go on indefinitely. Secondary amenorrhea is usually a temporary condition; the periods generally resume when the underlying cause for the interruption has been corrected.

Causes

Primary amenorrhea can be caused by an endocrine gland disorder (such as hyperthyroidism or hypothyroidism); genetic abnormalities; damaged or missing ovaries, uterus, or vagina; or an excessively thick hymen (the membrane that usually covers the vaginal opening in women who have not yet had sexual intercourse), which blocks the outflow of the menstrual discharge.

Secondary amenorrhea is most commonly caused by pregnancy. It can also be triggered by strenuous sports training, poor nutrition, drastic weight gain, jet lag, certain medications (including corticosteroids, tranquilizers, and birth control pills), major surgery or serious disease, emotional shock, or the loss of a large percentage of body fat.

Symptoms

Primary amenorrhea is commonly accompanied by abnormal or inhibited physical development; the young girl may fail to develop breasts or body hair, indicating that a genetic disorder may be preventing her from attaining sexual maturity. These girls are also usually short in height.

Secondary amenorrhea has no symptoms other than the absence of menstrual periods.

Diagnosis

Diagnostic evaluation of both types of amenorrhea will probably include a test to rule out pregnancy; tests to detect genetic or hormonal disorders, and X rays or ultrasound studies may also be done.

Treatment

Primary amenorrhea may be treated with extensive hormone therapy to stimulate physical development. If the cause is a thick hymen, a minor surgical procedure may be performed. Some cases of primary amenorrhea, however, are untreatable (for example, those caused by structural abnormalities of the reproductive organs).

Secondary amenorrhea may be treated with a hormone that will trigger ovulation and re-establish the menstrual cycle. However, quite often this condition will reverse itself without treatment, especially if the cause is merely an interruption in the patient's normal routine, an emotional upset, or pregnancy.

Prevention

Maintaining good nutritional habits and a normal weight and avoiding overly strenuous sports can probably be beneficial in preventing secondary amenorrhea. No specific precautions can be taken, however, to prevent primary amenorrhea.



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