Amenorrhea
What Is Amenorrhea?
Amenorrhea is the absence of menstrual periods. It is a common disorder among young women in their teens and early twenties, but can occur at any age. Amenorrhea can last for just a few months or may persist for many years. It may occur by itself, or may be accompanied by other symptoms such as hirsutism (excess hair growth) and acne.
What Are The Causes Of Amenorrhea?
Both ovulation (the production of an egg by the ovary) and menstrual periods are controlled by the pituitary gland. The pituitary gland is a small gland located in the center of the brain which acts as the "central computer" for a woman's hormone system. The pituitary system is very sensitive and responds to many different types of signals. The system is turned off by the hormones produced in pregnancy, and by hormonal medications such as birth control pills. It can also be affected by stresses such as illness, moving, family or relationship changes, strenuous exercise, or variations in body weight. Other less common causes of amenorrhea include medications, thyroid and other hormonal disorders, premature ovarian failure (or premature menopause), polycystic ovary syndrome, tumors of the ovaries or other glands, scarring of the cervix or uterus, and tumors of the pituitary gland itself.
What Tests Are Necessary For Amenorrhea?
A routine gynecology examination and regular PAP smear are important for all women. Amenorrhea should be evaluated with blood tests for hormones of the pituitary, thyroid, and/or ovaries if indicated. X-ray tests of the pituitary gland may be recommended in some cases. It is also sometimes necessary to give progesterone pills (Provera) to test for estrogen levels. Vaginal bleeding will occur if estrogen is being produced by the ovaries. It is important to be followed closely by a specialist for this disorder as tests often need to be repeated at regular intervals if regular periods do not resume. Amenorrhea can be an early sign of more serious problems which may not show up on tests in the early stages.
Is There Anything I Can Do About It?
There is usually not much that a woman can do about amenorrhea. Some women who are very underweight may benefit from weight gain, or from treatment of an eating disorder such as anorexia or bulimia if present. Women engaged in strenuous physical exercise programs (runners, gymnasts, etc.) may resume ovulatory cycles during rest periods from training. The great majority of women with these disorders will resume normal ovulatory menstrual cycles eventually, although this may take several months or even years.
Is Amenorrhea Harmful To My Body?
Amenorrhea lasting more than a few months can have several important long-term effects on a woman's body. Because amenorrhea can sometimes be a sign of a more serious problem (such as a tumor of the pituitary gland), tests are necessary to exclude one of these conditions.
Some women with amenorrhea will still produce their own estrogen hormone even though they are not ovulating. Prolonged production of estrogen by the ovaries without menstrual periods can cause cancer of the lining of the uterus (endometrium). This can be prevented by short treatment with progesterone hormone (Provera, etc.) each month, causing the lining of the uterus to shed like a menstrual period.
Women with amenorrhea who have very low estrogen levels may develop symptoms of menopause such as vaginal dryness, hot flushes (night sweats), or sleep disturbances. They are also at risk for accelerated osteoporosis (bone thinning) and cardiovascular disease including heart attacks and strokes in the future. Female athletes will be at an increased risk of stress fractures and other sports injuries. Women in this group require replacement of the missing hormones (estrogen and progesterone) to prevent these complications.
Lastly, if a woman is not ovulating, it may be very difficult to achieve a pregnancy. This problem can often be corrected by the use of fertility medications to induce ovulation.
What Is The Treatment For Amenorrhea?
Women producing their own estrogen will have menstrual periods with the monthly use of progesterone, such as Provera, or with birth control pills. This will prevent both the risk of cancer of the endometrium and problems with irregular vaginal bleeding later on.
Women who are not producing estrogen should take a low-dose hormone replacement program with both estrogen and progesterone, similar to the one used for women after the menopause. Low-dose birth control pills are an excellent alternative for patients who are also in need of contraception.
Women who are attempting pregnancy are usually treated with ovulation induction medications (fertility drugs) such as clomiphene (Clomid or Serophene) or gonadotropins (Pergonal/Metrodin).
