Primary Amenorrhea Causes Symptoms and Treatment

 

What is primary amenorrhea?

Primary Amenorrhea (первичная аменорея, انقطاع الطمث الأولي) is the absence of menstruation (menarche) that has not occurred by age 16. This usually occurs in the presence of normal growth and secondary sexual characteristics. If by age 13 menses has not occurred and the signs of puberty, such as breast development, are absent, a workup for primary amenorrhea should be initiated.

What is secondary amenorrhea?

Secondary Amenorrhea (вторичная аменорея, انقطاع الطمث الثانوي) is an abnormal gynecological disorder characterized by absent menstrual periods for three or more months in a girl or woman who had been menstruating. This usually occurs in the absence of lactation, pregnancy, cycle suppression with hormonal birth control pills, or menopause. A functional approach is helpful in ruling out the condition.

Symptoms

What are the symptoms of primary amenorrhea?

Depending on the cause of amenorrhea, symptoms of primary amenorrhea can include:

1. Absence of menses because it never started by age 16
2. Headache
3. Abdominal or pelvic pain
4. Depression
5. Emotional liability
6. Bloating
7. Headache
8. Bad appetite
9. Galactorrhea or milky nipple discharge
10. Hair loss or alopecia
11. Excessive facial hair growth (hirsutism)
12. Vision changes
13. Acne

Causes

What are the causes of primary amenorrhea?

Primary amenorrhea can result from two main causes:

1. Genetic or chromosomal abnormalities can lead to impairment of ovarian function
2. Hypothalamic or pituitary dysfunction can cause an imbalance of hormones that can stop and delay your period

Primary amenorrhea is usually associated with one of the following conditions:

Hypothalamic functional abnormality, evidence of structural and functional abnormalities in the hypothalamus of women experiencing amenorrhea has been confirmed. This syndrome may be caused by several factors such as alteration in GRH levels, anorexia, stress, glandular failure, drugs, pineal tumors, habitual causes, etc.

Pituitary metabolic problems, the pituitary (hypophysis) is called the master gland because it regulates the functions of other endocrine glands. Most cases of primary amenorrhea are caused by one of the following disorders: prolactin secreting pituitary tumor (prolactinomas), pituitary tumors, diabetes, congenital problems, cushings disease, TSH secreting pituitary tumor (TSH-oma, Thyrotropinoma), etc.

Ovarian disorders that affect women’s menstrual health include gonadal dysgensesis, autoimmune problems, testicular feminization syndrome, ovarian tumor, surgical removal of the ovaries, ovarian failure, etc.

Synthesis of progesterone and estradiol hormones in granulosa cells as a response to gonadotropins

Endometrial problems

If a woman is underweight, sudden weight loss can cause Amenorrhea

What is the most common cause of primary amenorrhea?

In the absence of secondary sex characteristics, low FSH and LH levels due to a pituitary disorder or hypothalamic problem (delayed puberty) are the most common causes of amenorrhoea. Other common causes include Gonadal dysgenesis, which is often associated with premature ovarian failure (primary ovarian insufficiency) or Turner’s Syndrome, a condition in which X chromosome is missing or structurally altered.

What are the causes of secondary amenorrhea?

Common causes of secondary amenorrhea include:

1. Pregnancy
2. Anovulation, often due to PCOD
3. Hyperprolactinemia (high prolactin levels)
4. Functional ovarian cysts
5. Drugs and medicines
6. Premature ovarian failure, a condition affecting 0.5-3.0% of women in childbearing age.
7. Premature menopause, a condition in which menopause occurs before the age of 40, it affects 1% of women under the age of 40
8. Stress and depression
9. Poor nutrition

Treatment

How to treat primary amenorrhea?

Classical treatment of primary amenorrhea includes:

Lifestyle modification is a gold standard therapy for psychological and hormonal problems

Reviewing the medicines and drugs a patient is taking to reduce the number and dosage of medications and ensure they are appropriate, as some medications and contraceptives, such as birth control pills and patches, can cause menstrual periods to stop

Hormone replacement therapy is the treatment of choice for Amenorrhea because such women often suffer from hormonal imbalances

Contraceptives are often used to treat Hirsutism

Next steps management

How to diagnose primary amenorrhea?

History disease and physical examination

Lab tests

1. Pregnancy Test to rule out pregnancy
2. Hormonal tests (FSH, LH, estrogen, TSH,T4, progesterone, prolactine, dopamine, parathyroid hormone)

Diagnostic procedures

1. X-ray of the skull
2. Pelvic and abdominal ultrasound
3. Hysteroscopy

 

 

 

References

Verified by: Dr.Diab (December 16, 2017)

Citation: Dr.Diab. (December 16, 2017). What is Primary Amenorrhea? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 8(2). urn:medcoi:article15585.