Amenorrhoea
Amenorrhoea is absense of a menstrual period in a women of reproductive age. However, it presents in two key ways: at the onset of periods, and during reproductive years:
Primary amenorrhoea
Definition
Menarche is delayed; the onset of periods hasn't happened by the age of 16, even though secondary sexual characteristics, thelarche (growth of breasts) and adrenarche (growth of pubic hair), have occured.
Common Causes
They are mostly odd, genetic and rare, except for the first one
- Anorexia nervosa - this is the most common by quite a long way.
- Congenital genital tract malformations - Turners, Mullerian agenesis, etc.
- Androgen insufficiency
Management
Basically, if they have anorexia, sort that out. Otherwise, if the problem is an obscure genetic problem, there may not be much that can be done to restore normal fertility. Ultimately though, management of the problem will be the way to deal with the amenorrhoea.
Secondary amenorrhoea
Definition
Absense of a menstrual period in a women of reproductive age, for at least 6 months.
Common Causes
In secondary, there are three mega causes:
Aside from these, its mostly things like:
- PCOS
- Premature menopause
- Hyperprolactinaemia (they stop having periods and start lactating!)
- Thyroid problems
- Androgen tumours
Management
Again, the treatment is linked to the cause. Often, in the case of early menopause, there is often nothing that can be done, since sometimes the ovary runs out of eggs, at which point periods become a bit pointless, since a monthly time of reproductive support in the uterus isn't much help if there's nothing to put there. However, often those with premature menopause can become fertile enough to allow implantation of donor eggs.
With the various endocrine/pituitary disorders, treatment of the disorder is almost always the route to treatment of the amenorrhoea.