Amenorrhea (or absence of menstruation) : Facts And Possible Treatments We Need To Know
Tuesday, January 31,2017
Amenorrhea is the absence of menstruation in a woman of reproductive age. The word “amenorrhea” comes from the Greek has for privation, even for months .
Between 2% and 5% of women would be affected by amenorrhea. It is a symptom of which it is important to know the cause.
The absence of menstruation is quite natural when, for example, the woman is pregnant, breastfeeding or approaching menopause. But apart from these situations, it can be a sign indicative of chronic stress or even a health problem such as anorexia or a disorder of the thyroid gland.
Types Of Amenorrhea
Primary amenorrhea: when at the age of 16, the rules have not yet been triggered. Secondary sexual characteristics (development of chest, pubic hair and armpits and distribution of adipose tissue in the hips, buttocks and thighs) may nevertheless be present.
Secondary amenorrhea: when a woman has already been menstruating and ceases to be menstruating for one reason or another over a period equal to at least 3 intervals of previous menstrual cycles or 6 months without menstruation.
When to consult when there are no rules?
Often, not knowing why you are suffering from amenorrhea is a concern. The following persons should consult a physician:
– women with primary or secondary amenorrhea;
- In cases of post-contraceptive amenorrhea, a medical evaluation is necessary if amenorrhea persists more than 6 months in women who have been on birth control pills, having worn a hormonal IUD Mirena, or more than 12 months after the last injection Of Depo-Provera®.
Important. Sexually active women who do not take hormonal contraception should take a pregnancy test if their period is delayed for more than 8 days, even when they are “certain” not to be pregnant.
Note that bleeding that occurs under hormonal contraceptive (especially the false rules generated by the contraceptive pill) are not evidence of non-pregnancy.
Diagnosis of amenorrhea
In most cases, clinical examination, a pregnancy test and sometimes an ultrasound of the sexual organs are sufficient to guide the diagnosis.
A wrist radiograph (to assess pubertal development), hormonal assays or chromosomal sex are performed in rare cases of primary amenorrhea.
Causes of lack of rules
There are many causes of amenorrhea. Here are the most frequent in descending order.
The pregnancy. The most common cause of secondary amenorrhea, it should be the first suspected in a sexually active woman. Surprisingly, this cause is often discarded without prior verification, which is not without risk. Some treatments indicated to treat amenorrhea are contraindicated in pregnancy. And with commercially available tests, the diagnosis is simple.
A delay of puberty without gravity. This is the most common cause of primary amenorrhea. The age of puberty is normally between 11 and 13 years, but can vary greatly depending on ethnicity, geographic location, diet, and health status.
In developed countries, delayed puberty is common in young women who are very thin or athletic. It would seem that these young women do not have enough fat to allow the production of estrogen hormones.
Estrogens allow thickening of the uterine wall, and later menstruation if the egg has not been fertilized by a spermatozoon. In a way, the bodies of these young women naturally protect themselves and report that their fitness is inadequate to support a pregnancy.
If their secondary sexual characteristics are present (appearance of breasts, pubic hair and armpits), there is no worry to have before the age of 16 or 17 years. If signs of sexual maturation are still absent at the age of 14, a chromosomal problem (a single sex chromosome X instead of 2, a disease known as Turner’s syndrome) must be suspected, a Development of the reproductive system or a hormonal problem.
Breastfeeding. Often women who are breast-feeding do not have menstruation. However, it should be noted that they can still have an ovulation during this period, and therefore a new pregnancy. Breast-feeding suspends ovulation and protects against pregnancy (99%) only if:
– the baby takes exclusively the breast;
– the baby is less than 6 months old.
Evolution and possible complications
The duration of amenorrhea depends on the underlying cause. In most cases, amenorrhoea is reversible and is easily treated (except, of course, amenorrhea due to genetic abnormalities, nonoperable malformations, menopause or ablation of l Uterus and ovaries).
However, when long-term amenorrhea is left untreated, the cause may eventually reach reproductive mechanisms.
In addition, amenorrhea associated with a lack of estrogen (amenorrhea caused by demanding sports or eating disorders) increases the risk of osteoporosis in the long term – thus fractures, instability of the vertebrae And lordosis – since estrogens play an essential role in preserving bone structure.
It is now well known that female athletes with amenorrhea have lower bone density than normal, which is why they are more prone to fractures. If moderate exercise helps prevent osteoporosis, excess exercise, on the other hand, has the opposite effect if not balanced by higher caloric intake.
In the case of ovarian dysfunction in a young woman, hormone treatment will be suggested so that development of sexual characteristics and fertility occurs, and to prevent osteoporosis in the long term.
For women who have undergone surgical removal of the uterus and ovaries very early (before the presumed age of their menopause), surrogate hormone therapy including estrogen and progestin may be proposed to prevent osteoporosis and other Consequences due to the lowering of circulating hormone levels.
This treatment can be interrupted around 55 years.
Caution: this treatment can not be prescribed to women who have undergone an ablation of the uterus or ovaries for hormone-dependent cancer.
It can not be prescribed for women who have undergone ovarian castration by radiotherapy or chemotherapy for breast cancer.
Apart from these situations, no hormonal treatment is effective in bringing about the return of the rules.
On the other hand, “regularized cycle” treatments (for example, taking a synthetic progestin in the second half of the cycle for women with irregular periods who would like a regular cycle to conceive) are not based on any scientific basis.
They can even contribute to accentuate the disorders of the menstrual cycle by compromising the spontaneous occurrence of the ovulations. It is not the regularity of the cycle that counts, but the respect of the cycle as it is in a given woman.
When amenorrhea is due to a high prolactin secretion associated with a benign pituitary tumor, bromocriptine (Parlodel®) is a highly effective drug that decreases prolactin levels and allows for the return of menstruation. It is the same treatment given to women who do not wish to breastfeed immediately after delivery.
If amenorrhea is accompanied by a psychological disorder, the doctor may offer psychotherapy.
Parallel use of hormonal treatments can be discussed, depending on the age of the woman, the duration of amenorrhea and the adverse effects of hormonal deficiency (if any). However, psychotropic drugs should be avoided, as they may cause amenorrhea.
Amenorrhea associated with anorexia necessitates follow-up by a multidisciplinary team including nutritionist, psychotherapist, psychiatrist, etc. Anorexia often affects adolescents or young women.
In cases of serious psychological trauma (rape, loss of a loved one, accident, etc.) or personal conflicts (divorce, financial difficulties, etc.), an amenorrhea lasting several months, Especially in a woman whose psychic balance was already fragile. The best treatment is then to consult a psychotherapist.
If amenorrhea is caused by a malformation of the reproductive system, surgery can sometimes be undertaken (in case of imperforation of the hymen for example).
But if the malformation is too great (Turner syndrome or insensitivity to androgens), surgery will only have a cosmetic and comfort function by altering the appearance and functionality of the undeveloped sexual organs, but will not “return” the rules .
Tuesday, January 31,2017-14:46:29[London]
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