The Absence Of Menstruation Or Amenorrhea

The absence of menstruation or amenorrhea often triggers waves of thoughts in the minds of many women

I have put together in this page the basic info which I have found useful for many women seeking help about such questions.

What Is Amenorrhea?

Amenorrhea is basically the absence of menstruation. It results from an interference with the processes involved in the normal menstrual cycle.

 Late or Absent Menstruation

These three words have been used by women to talk about a similar problem about absent menstrual flow. These words point to the same direction but are not really the same in every respect practically.

• Absence of menses could be used for all cases of amenorrhea whether for those who have had menses before or not.
• Missed period implies the menstrual flow was expected but did not occur. A range of emotions can result the first time this is identified.
• Late menstruation usually carries a similar connotation like missed menstruation. Late menstruation implies the woman knows the expected date of menses but the flow has not yet shown up as usual based on her past experience. Women often allow some few days of waiting to make an allowance for an unusual irregularity. As a woman waits and yet does not see any menstrual flow, the term late is appropriate. It could also be used if the late menses finally shows up but with an usual delay. Such delays or unusual prolongation of the cycle is no longer amenorrhea because the menses finally come but may be another indication of an abnormal cycle.

Types Of Amenorrhea

The absence of menstruation has been traditionally divided in two main types depending on the causes and its relationship to puberty. The distinction is usually so obvious. The two groups are primary and secondary amenorrhea.

• Primary.Primary amenorrhea is the absence of menstruation and secondary sexual characteristics such as pubic hair and breasts development, in a girl by age 14 years or the absence of menstrual bleeding with normal development of such secondary sexual characteristics in a girl by age 16 years.
• Secondary. Secondary amenorrhea
  is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for 3 or more months in the absence of any of the known physiologic or drug-induced causes of absence of menstruation.

Causes of Amenorrhea

The likely cause of the absence of menstruation depends on what type of amenorrhea is at hand. Whether primary or secondary, similar structures could be involved.

The causes of amenorrhea may either affect structures that produce the female hormones (the hypothalamus-pituitary gland-ovaries) or the genital structures involved in bleeding( uterus and vaginal).

When To Seek Medical Care

Women will often not seek medical care when they first notice a missed menstruation except there is a specific reason prompting this.

• For adolescents, the parents often notice abnormal pointers or some girls may report the abnormality often after discussing with friends. For young girls, medical care should be sought whenever a girl is 14 years old and does not yet show secondary sexual characteristics and menses or is 16 years old with secondary sexual characteristics but does not yet menstruate. Home therapy of whatever sort should not be attempted at home until a full medical evaluation has clearly deciphered the cause.
• For women who have been having regular menstrual flow, medical care should be sought after three missed period in the absence of the known physiologic and drug-induced causes mentioned above. For women with previous irregular cycles, a time limit of 6 months is usually used to defined amenorrhea and so these women with such cycles can wait for 6 months before seeking medical care.

Medical Evaluation

Medical evaluation usually seeks to identify which structure is involved and the probable cause responsible. Investigations may include lab work or imaging studies.

Common lab tests may include measurement of menstruation hormones. Other lab test could be requested based on what is suspected as the cause like thyroid hormones.

The most common imaging studies used is ultrasound imaging to evaluate the genital tract or ovaries. The brain structures could be evaluated with CT scans of MRI.

Treatment

The treatment of amenorrhea is cause-specific. The underlying cause must be identified and a specific therapy instituted whether with medications or surgery.

In general, diseases that alter the hormonal functioning could be addressed with medications, for instance Dopamine agonists like bromocriptine in treating high prolactin levels or Hormone Replacement Therapy with deficient menstruation hormones like estrogen. The regular birth control pills could also be used in some cases.

Surgery is usually used to treat structure genital tract abnormalities like vaginal septum or in some cases of tumors.

Home Care

Home care will be required following medical evaluation for functional absence of menstruation. As mentioned above, no home care should be identified until full medical evaluation is done and the specific therapy instituted including those that could be continued as home care.

Do remember that the functional causes above are only identified as the culprit only after other causes have been excluded.

The following strategies are used to treat or even prevent causes of functional amenorrhea

• Healthy balanced diet to resolve the problems about malnutrition.
• Methods to relieve stress if stress is identified as the cause. All should be done to address the origin of stress and not just rely on medications.
• Moderation of physical activity. A mild to moderate exercise should be implemented if possible if excessive physical activity is identified as the likely cause.
• Maintenance of an idea body weight. Both overweight and underweight should be corrected.
• Alcohol and nicotine use should be avoided.

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