Amenorrhea

Amenorrhea is the medical term for the absence of menstrual periods, either on a permanent or temporary basis. Amenorrhea can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.

The menstrual cycle can be influenced by many internal factors such as transient changes in hormonal levels, stress, and illness, as well as external or environmental factors. Missing one menstrual period is rarely a sign of a serious problem or an underlying medical condition, but amenorrhea of longer duration may signal the presence of a disease or chronic condition.


causes of  amenorrhea

The normal menstrual cycle occurs because of changing levels of hormones made and secreted by the ovaries. The ovaries respond to hormonal signals from the pituitary gland located at the base of the brain, which is, in turn, controlled by hormones produced in the hypothalamus of the brain. Disorders that affect any component of this regulatory cycle can lead to amenorrhea. However, a common cause of amenorrhea in young females sometimes overlooked or misunderstood by the individual and others, is an undiagnosed pregnancy. Amenorrhea in pregnancy is a normal physiological function. Occasionally, the same underlying problem can cause or contribute to either primary or secondary amenorrhea. For example, hypothalamic problems, anorexia or extreme exercise can play a major role in causing amenorrhea depending on the age of the person and if she has experienced menarche.

Primary amenorrhea

Primary amenorrhea is typically the result of a genetic or anatomic condition in young females that never develop menstrual periods (by age 16) and is not pregnant. Many genetic conditions that are characterized by amenorrhea are conditions in which some or all of the normal internal female organs either fail to form normally during fetal development or fail to function properly. Diseases of the pituitary gland and hypothalamus (a region of the brain important for the control of hormone production) can also cause primary amenorrhea since these areas play a critical role in the regulation of ovarian hormones.

Gonadal dysgenesis is the name of a condition in which the ovaries are prematurely depleted of follicles and oocytes (egg cells) leading to premature failure of the ovaries. It is one of the most common cases of primary amenorrhea in young women.

Another genetic cause is Turner syndrome, in which women are lacking all or part of one of the two X chromosomes normally present in the female. In Turner syndrome, the ovaries are replaced by scar tissue and estrogen production is minimal, resulting in amenorrhea. Estrogen-induced maturation of the external female genitalia and sex characteristics also fails to occur in Turner syndrome.

Other conditions that may be causes of primary amenorrhea include androgen insensitivity (in which individuals have XY (male) chromosomes but do not develop the external characteristics of males due to a lack of response to testosterone and its effects), congenital adrenal hyperplasia, and polycystic ovary syndrome (PCOS).


Symptoms of primary amenorrhea may include:

Headaches
Abnormal blood pressure
Vision problems
Acne
Unwanted hair growth


Secondary amenorrhea

Pregnancy is an obvious cause of amenorrhea and is the most common reason for secondary amenorrhea. Further causes are varied and may include conditions that affect the ovaries, uterus, hypothalamus, or pituitary gland.

Hypothalamic amenorrhea is defined as amenorrhea that is due to a disruption in the regulator hormones produced by the hypothalamus in the brain. These hormones influence the pituitary gland, which in turn sends signals to the ovaries to produce the characteristic cyclic hormones. A number of conditions can affect the hypothalamus and lead to hypothalamic amenorrhea, such as:

extreme weight loss,
emotional or physical stress,
rigorous exercise, and
severe illness.
Other types of medical conditions can cause secondary amenorrhea:

tumors or other diseases of the pituitary gland that lead to elevated levels of the hormone prolactin (which is involved in milk production) also cause amenorrhea due to the elevated prolactin levels;
hypothyroidism;
elevated levels of androgens (male hormones), either from outside sources or from disorders that cause the body to produce too high levels of male hormones;
ovarian failure (premature ovarian failure or early menopause);
polycystic ovary syndrome; and
Asherman's syndrome is an example of uterine disease that causes amenorrhea. It results from scarring of the uterine lining following instrumentation (such as dilation and curettage) of the uterine cavity to manage postpartum bleeding or infection.
Post-pill amenorrhea

Women who have stopped taking oral contraceptive pills should experience the return of menstruation within three months after discontinuing pill use. Previously, it was believed that birth control pills increased a woman's risk of amenorrhea following use of the pill, but this has been proven not to be the case. Women who do not resume menstruation after three months have passed since oral contraceptive pills were stopped should be evaluated for causes of secondary amenorrhea.


Symptoms of secondary amenorrhea may include:

Nausea
Swollen breasts
Headaches
Vision problems
Being very thirsty
Goiter, an enlarged thyroid gland
Darkening skin
Hot flashes, mood changes, depression, and vaginal dryness are common with estr



Aconite – suppression of menses in plethoric girls, fear and restlessness is well marked in girls.

apis mel -menses supressed with head symptoms or due to tomor in the ovaries

Calcaria carb – suppression of menses on girls, who are fat, swelling and tenderness during menses, headache, chilliness and colic before menses

Apocynum – absence of menses in tropical conditions, dropsical swelling or distended abdomen, weakness and nervousness due to non appearance of menses

Graphites – menses delayed and scanty or there is suppression of menses, usually associated with constipation

Onosmodium – patient has feeling as if menses would appear soon but does not appear

Opium –suppression of menses due to fright

Cimicifuga – amenorrhea due to endocrinal disorders

Phosphorous – remarkable remedy for amenorrhea, bleeding from nose, eyes instead of menses

Causticum – menses during day only, ceases during night. Well known medicine for amenorrhea

Apis Mel – amenorrhea or suppression of menses due to tumor in ovaries, acts well in young girls.

Kali carb – delayed menses in young girls, suppression of menses from fright

Lycopodium – amenorrhea in young girls with underdeveloped breasts, suppression of menses from fright.

Colocynth – there is suppression of menses due to anger

Ignatia – amenorrhea or suppressed menses; grief, changeable mood in females

Pulsatilla – excellent remedy for amenorrhea, whatever the cause is this remedy acts remarkably

Sepia – absence of menses after breastfeeding of child,

Sulphur – too late menstruation, scanty and difficult menses, blood thick, black and excoriating

Thyreoidinum – amenorrhea due to over activity of pituitary gland

Pinus lamb. – Menses suppressed and delayed.