Sometimes there is the absence of a menstrual period in a woman of reproductive age. Physiological states of absence of menstruation 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.
Amenorrhoea is a symptom with many potential causes.
Amenorrhoea is associated with some diseases such as Turner’s syndrome, hyperprolactinemia, anorexia nervosa, Asherman syndrome and Müllerian agenesis.
Turner’s syndrome is a syndrome of defective gonadal development in phenotypic females mostly associated with the karyotype 45,X. Patients generally present with primary amenorrhoea with failure to develop secondary sex characteristics (sexual infantilism). Interestingly menarche and ovarian function are essentially regulated by two genes on X chromosome. Most women with Turner syndrome have only one copy of the gene in each cell instead of the usual two copies.
Prolactin (PRL) is one of several hormones that are produced by the pituitary gland. PRL has many different roles throughout the body, and most of those are clearly shown as clinical symptom. Perhaps the most important classical role of prolactin is to stimulate milk production in women after the delivery of a baby. During the first several months of breastfeeding, the higher basal prolactin levels also serve to suppress ovarian cyclicity, through the inhibition of pituitary hormones, mainly via LH suppression. This is the reason why women who are breastfeeding do not get their periods and therefore do not often become pregnant. In actively breastfeeding mothers the related hyperprolactinaemia persisting even over a year. Clinically significant elevation of PRL levels may cause infertility in several different ways. Prolactin may stop a woman from ovulating. If this occurs, a woman’s menstrual cycles will stop.
The unlimited availability of nutrients, in association with reduced energy expenditure, leads to alterations in many metabolic pathways and to impairments in the finely tuned inter-relation between energy metabolism and reproduction, thereby affecting female fertility. Low leptin (a hormone made by adipose cells that helps to regulate energy balance by inhibiting hunger) serum concentrations were observed in amenorrheic athletes and in women with anorexia nervosa and could, at least in part, explain the hypothalamic amenorrhea affecting those patients.
Asherman syndrome is characterized by variable scarring inside the uterine cavity and it is also cause of menstrual disturbances, infertility and placental abnormalities. Intrauterine adhesions can lead to partial or complete dysfunction of the endometrium with impairment of fertility and menstrual pattern amenorrhea.
In women with primary amenorrhea, approximately 15% have abnormal genital examination, with Müllerian agenesis being the second most frequent cause (10%). It is a congenital aplasia (defective development or congenital absence of an organ or tissue) of the uterus and the upper part (2/3) of the vagina.
Amenorrhoea is also asociated with others conditions (premature ovarian failure, endometrial hyperplasia, cervical stenosis) but there are rare.
The ovum-producing organs of the internal female reproductive system
An eating disorder characterized by the maintenance of a body weight below average, fear of gaining weight, and a distorted body image.
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 medical condition, where the walls of the uterus stick to one another due to bands of scar tissue.
A type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis.
The loss of function of the ovaries before age 40.
A medical term which describes a diminished functional activity of the gonads – the testes and ovaries.
The time in most women's lives when menstrual periods stop permanently, and the woman is no longer able to have children.
The absence of a menstrual period in women of reproductive age.
Thickening of the lining of the uterus.
Inborn morphological deviation of the uterus - one of the Müllerian duct anomalies where the uterine cavity is divided in the upper part.
Narrowing of cervix - the opening to the uterus.
Surgical removal of one or both ovaries.
Condition that occurs due to excessive production of thyroid hormone by the thyroid gland.
The presence of abnormally high levels of prolactin in the blood.
A lower than normal level of estrogen which is the primary sex hormone in women.