Amenorrhea is the non-occurrence of menstrual cycle (monthly menses period), in a woman.   Amenorrhea is of two types:     1. Primary amenorrhea.   2. Secondary amenorrhea.   1. Primary amenorrhea: It is also naturally occurs in females due to physiological phenomenon. This is called physiological amenorrhea.   I. Before menarche, there are no menstrual cycles in a female. (Menarche means occurring of M.C for the first time in a woman’s life usually at 14-16 years of age).   Ii. During pregnancy.   Iii. After menopause (usually after attaining the age of 45-50 years), there will be no regular M.Cs (menstrual cycles) in a woman.   Normal menses helps woman in two ways:   To keep a woman in normal health.   Helps woman to become pregnant.    1. Primary amenorrhea:   Causes:   Hormones imbalance.   -- Differences in chromosome pattern.   --Absence of uterus or vagina since birth (congenital defect).   --Closure of the vaginal opening or completely contracted.   -- having a very weak body.   -- Suffering from psychological problems.   --Juvenile diabetes or goiter (thyroid problem).   --Tuberculosis.   --Polycystic ovary disease.   Management of the case: The following investigations have to be done to find the cause or causes for further treatment and follow up. Depending on the cause, the treatment has to be given.   i). Ultrasound scanning: Uterus, vagina and other parts of the body can be visualized, if there is any abnormality, it can be identified and rectified.   ii).Genetic choreotyping.   iii).Androgen estimation assays.   iv). Renal function tests.     2. Secondary amenorrhea:   Here, the woman has regular M.Cs. After sometime there will be no monthly periods. If there are no monthly cycles continuously for six months, then the doctor diagnoses that she is suffering from secondary amenorrhea.     Causes:   1. Removal of cervix by operation –for the cervical erosion or cancer of the cervix.   2. Doing repeatedly D&C minor surgical interventions in the uterus for certain uterine causes.   3. T.B of endometrium (uterine wall).   4. Removal of the ovaries for ovarian diseases, like tumors in the ovaries etc.   5. Anorexia nervosa (loss of appetite due to not taking sufficient food) and obesity.   6. Tumors like –adenoma and Prolactinoma.   7. False pregnancy (pseudocysis) and also stress and strain leads to amenorrhea.   8. Doing heavy exercises, leads to bodily dysfunction.   9. Pyogenic infections and mumps.     Investigations:   --Pregnancy test and ultrasound scanning test to confirm or rule out the pregnancy. --Tests for serum prolactin levels, oestradiol levels, and positive progesterone challenge tests are to be done.   -- The other tests have to be done as in the case of primary amenorrhea to find out the actual cause for amenorrhea and treatment has to be given depend upon the cause.   The treatment may be either medical or surgical or sometimes both are required. … [Read more...]