BE, amenorrhea (AmE), amenorrhœa
Amenorrhea is the absence or abnormal cessation of the menses in a woman of reproductive age. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation (breastfeeding), the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method. Outside of the reproductive years there is absence of menses during childhood and after menopause. Determining the cause of your amenorrhoea is necessary in order to begin appropriate management. Your doctor will need to ask for detailed information regarding your general health, sexual and physical development, diet and exercise habits as well as inquire about any family history of similar problems. Your doctor may also need to perform a physical examination, which may include the breasts (to check for normal development) and the pelvis (to look for any obvious abnormalities). In addition to this, you may be required to have a blood test, to look at hormone levels in the blood (including pregnancy hormones, FSH, LH, testosterone, prolactin and thyroid), and imaging studies such as an ultrasound of the pelvis or a scan of the head or pelvis.
There are two primary ways to classify amenorrhoea. Types of amenorrhoea are classified as primary or secondary, or based on functional "compartments". The latter classification relates to the hormonal state of the patient that hypo-, eu-, or hypergonadotropic (whereby interruption to the communication between gonads and follicle stimulating hormone - FSH causes FSH levels to be either low, normal or high).
A) Classification by primary vs. secondary type:
B) Classification by compartment: the reproductive axis can be viewed as having four compartments:
Associated diseases
Amenorrhoea may have a very negative impact on fertility. Many women with amenorrhoea are anovulatory. An anovulatory cycle is a menstrual cycle during which the ovaries do not release an oocyte. If ovulation does not take place then of course pregnancy becomes impossible.
Preventing the large stress and excessive physical activity.
Decreasing the amount and intensity of exercise
"Athletic" amenorrhoea which is part of the female athlete triad (a syndrome in which eating disorders, amenorrhoea/oligomenorrhoea, and decreased bone mineral density - osteoporosis and osteopenia are present) is treated by eating more and decreasing the amount and intensity of exercise. If the underlying cause is the athlete triad then a multidisciplinary treatment including monitoring from a physician, dietitian, and mental health counselor is recommended, along with support from family, friends, and coaches.
Practice of Yoga Nidra is a simple method of relaxation which is practiced in the flat lying position of shavasana (lying on the back, the arms and legs are spread at about 45 degrees), and followings the spoken instruction of yoga therapist. Yoga Nidra can be an effective practice to overcome the psychiatric morbidity associated with menstrual irregularities apart from bringing the hormonal profile towards normalcy. Therefore, Yogic relaxation training (Yoga Nidra) could be prescribed as an adjunct to conventional drug therapy for menstrual dysfunction.
Although oral contraceptives can causes menses to return, oral contraceptives should not be the initial treatment as they can mask the underlying problem and allow other effects of the eating disorder, like osteoporosis, continue to develop. Weight recovery, or increased rest does not always catalyze the return of a menses. Recommencement of ovulation suggests a dependency on a whole network of neurotransmitters and hormones, altered in response to the initial triggers of secondary amenorrhoea. To treat drug-induced amenorrhoea, stopping the medication on the advice of a doctor is a usual course of action.
As for physiological treatments to hypothalamic amenorrhoea, injections of metreleptin (r-metHuLeptin) have been tested as treatment to oestrogen deficiency resulting from low gonadotropins and other neuroendocrine defects such as low concentrations of thyroid and IGF-1. R-metHuLeptin has appeared effective in restoring defects in the hypothalamic-pituitary-gonadal axis and improving reproductive, thyroid, and IGF hormones, as well as bone formation, thus curing the amenorrhoea and infertility. However, it has not proved effective in restoring of cortisol and adrenocorticotropin levels, or bone resorption.
Looking at hypothalamic amenorrhoea, studies have provided that the administration of a selective serotonin reuptake inhibitor (SSRI) might correct abnormalities of Functional hypothalamic Amenorrhoea (FHA) related to the condition of stress-related amenorrhoea. This involves the repair of the PI3K signaling pathway, which facilitates the integration of metabolic and neural signals regulating gonadotropin releasing hormone (GnRH)/luteinizing hormone (LH). In other words, it regulates the neuronal activity and expression of neuropeptide systems that promote GnRH release. However, SSRI therapy represents a possible hormonal solution to just one hormonal condition of hypothalamic amenorrhoea. Furthermore, because the condition involves the inter workings of many different neurotransmitters, much research is still to be done on presenting hormonal treatment that would counteract the hormonal affects.
Surgical therapy
Surgical therapy for amenorrhoea is not common, but may be recommended in some conditions (uterine scarring, pituitary tumor).
Amenorrhoea remains a clinically challenging entity because in vitro fertilisation (IVF) with donor oocytes is currently the only treatment known to be effective. Most such IVF patients will conceive from treatment using oocytes from an anonymous oocyte donor. As with all types of donor gamete therapy, pre-treatment counselling is very important.
An eating disorder characterized by the maintenance of a body weight below average, fear of gaining weight, and a distorted body image.
A condition in which a woman has an imbalance of female sex hormones. This may lead to changes in the menstrual cycle, cysts in the ovaries, trouble g
Failure of the ovaries to release an oocyte over a period of time generally exceeding 3 months.
An abnormal condition in a woman's menstrual cycle.
Turner syndrome is a genetic disorder in which a female is partly or completely missing one X chromosome that results in ovarian dysgenesis.
A genetic condition where the primary symptom is a failure to start puberty or a failure to fully complete puberty.
A type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis.
A medical term which describes a diminished functional activity of the gonads – the testes and ovaries.
Thickening of the lining of the uterus.
The most common benign smooth muscle tumors of the uterus encountered in women of reproductive age.
Narrowing of cervix - the opening to the uterus.
A lower than normal level of estrogen which is the primary sex hormone in women.
A form of abdominal adhesions in the pelvis.
A medical condition characterized by excessive levels of androgens in the body.
A region of the forebrain that regulates body temperature, some metabolic processes and governs the autonomic nervous system.
The ovum-producing organs of the internal female reproductive system
An endocrine gland, about the size of a pea, whose secretions control the other endocrine glands and influence growth, metabolism, and maturation.
One of the largest endocrine glands in the body, controls rate of use of energy sources, protein synthesis, and body's sensitivity to other hormones.
A female germ cell involved in reproduction.
A hormone, that provokes the regression of male fetal Müllerian ducts.
FSH is a hormone secreted by the anterior pituitary gland. It regulates the development, growth, pubertal matur and reproductive functions of the body
A releasing hormone responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary.
A hormone that supports the normal development of an egg in a woman's ovary, and stimulates the release of the egg during ovulation.
A hormone, that stimulates ovulation and the development of the corpus luteum in females, and the production of androgens in males.
Steroid hormone, secreted by the ovaries, whose function is to prepare the uterus for the implantation of a fertilized ovum and to maintain pregnancy.
Steroid hormone produced primarily in the testes of the male; responsible for the development of secondary sex characteristics in the male.
Tyrosine-based hormones produced by thyroid gland and that regulate metabolism, heat production, protein synthesis, and many other body functions.
A hormone that stimulates the thyroid gland to produce thyroxine, and then triiodothyronine, which stimulates the metabolism of tissue in the body.
Period when the womb is receptive for implantation of the free-lying blastocyst.
The fusion of an ovum with a sperm to initiate the development of a new individual organism.
Development of ovarian follicles from primordial to tertiary under the stimulation of gonadotropins.
The very early stage of pregnancy at which the embryo adheres to the wall of the uterus.
The process of the maturation of the female gametes through the meiotic division.
The release of egg(s) from the ovaries.
A mental disorder defined by abnormal eating habits that negatively affect a person's physical or mental health.
The toxic effect of certain metals in certain forms and doses on life.
A diminished level of blood estrogen level.
A common term for any practice of, or training for, a concrete sport which is in excess of that necessary to effectively participate in the sport.
Eating habits are one of the few factors within our control that impact not only our chances of falling pregnant.
Abuse of anabolic-androgenic steroids to control and develop one's musculature.
The absence of a menstrual period in a woman of reproductive age.
A long-term skin condition characterized by areas of blackheads, whiteheads, pimples, greasy skin, and possibly scarring.
Pain in the area of the pelvis, that lasts more than six months.
An organism has passed the usual age of onset of puberty with no physical or hormonal signs.
The excessive hairiness on women in those parts of the body where terminal hair normally is absent or minimal, such as a beard or chest hair.
A hair loss that frequently occurs due to an underlying susceptibility of hair follicles to androgenic miniaturisation.
The symptom of pain anywhere in the region of the head.
The failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
A decreased ability to see and hear to a degree that causes problems.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
It is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.
A physical, mental, and spiritual practice or discipline which originated in India.
