What is Amenorrhea?
Amenorrhea is a medical condition in which the menstrual cycle in women of a reproductive age stops suddenly. It is not a disease in itself but is an indication of potential diseases. Amenorrhea has been observed in both teenage girls and middle-aged women. In teenage girls, it manifests as an extended delay or failure to reach puberty.
Types of Amenorrhea
There are two types amenorrhea – primary and secondary amenorrhea:
- Primary amenorrhea: It is described as the delay in beginning puberty. Any delay in reaching puberty may mean hormonal imbalances in the body that can affect growth and development in a major way.
- Secondary amenorrhea: It is observed in women who have gone through menstrual cycles in the past. A sudden stop in the menstrual cycle in young and middle-aged women is also concerning, and can have serious impacts on health and quality of life.
Causes of Amenorrhea
Amenorrhea can occur as a result of improper functioning of any of the following four hormones:
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
The hypothalamus and pituitary glands are responsible for the release of hormones such as follicle-stimulating hormone and luteinizing hormone. These two hormones stimulate the ovaries and the uterus to produce estrogen and progesterone hormones. These two hormones are responsible for menstruation. Women have menstrual cycles regularly when the hypothalamus, pituitary gland, ovaries, and uterus function properly.
The other most common causes of amenorrhea include:
- Pituitary causes: Pituitary causes are responsible for diseases such as prolactinemia, Cushing syndrome, acromegaly, postpartum pituitary necrosis, autoimmune hypophysitis, pituitary radiation, and sarcoidosis.
- Hypothalamic causes: Hypothalamic causes of amenorrhea are normally experienced by women who are on a diet, trying to lose weight, or are exercising regularly. Hypothalamic amenorrhea has been linked with energy deficiencies in women who do regular and heavy workouts regularly but do not replenish their bodies with the required amount of calories. It is responsible for diseases such as craniopharyngioma (brain tumor at the pituitary gland), teratoma (a tumor with a mix of tissues), sarcoidosis, Kallmann syndrome, and a range of nutritional deficiencies.
- Ovarian causes: Ovarian causes which are responsible for amenorrhea include anovulation, hyperandrogenemia, polycystic ovary syndrome (PCOS), pure gonadal dysgenesis, and autoimmune oophoritis. Other causes include delicate X premutation, galactosemia, intrauterine adhesions, premature ovarian failure, Turner syndrome, imperforate hymen, and aplasia.
- Functional causes: These causes for amenorrhea include anorexia, tuberculosis, malnutrition, psychological issues such as depression, substance abuse, anti-depressant use and/or behavior change, drug abuse, or stress.
- Medication-induced causes: Regular and long-term use of medications such as regular contraceptives or hormonal contraceptives can induce the condition by stopping the menstruation process.
The notable symptoms of amenorrhea include the following:
- Galactorrhea: It is a condition in which the process of lactation starts in women who are neither pregnant nor breastfeeding.
- Hirsutism: It is a condition seen in women who have hair growth similar to adult men. This is caused by a hormone called androgen being produced in excessive amounts in the body.
- Change in voice: Voice changes in amenorrhea have been observed, usually deepening to a male register or range.
- Vaginal dryness: It is another symptom of amenorrhea where the vagina is unable to maintain adequate moisture levels due to hormonal imbalance. These fluids that are very acidic in nature act like a second wall of defense against bacterial, fungal and viral infections.
- Significant weight gain or weight loss: Women suffering from amenorrhea are known to either gain weight or lose weight. In cases of excess weight gain, insulin resistance has also been observed, which can lead to diabetes.
- Frequent headaches: They have often been observed in women with amenorrhea.
- High levels of anxiety: Anxiety in women with prior psychiatric issues can be one of the causes.