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Amenorrhea: When A Woman Doesn't Menstruate

August 17, 2010

Primary and Secondary Amenorrhea

Most young girls have a secret wish to start their periods early - or at least as soon as their friends have begun to menstruate. Generally, girls experience menarche between the ages of 11-14, however, sometimes they are a little younger and sometimes a little older. Primary amenorrhea, the absence of menstruation, can happen during puberty or later on, but it is indicated by not having a period by age 16. Secondary amenorrhea occurs when menstruation has been established and then periods stop coming. The obvious first thought is pregnancy, but there are many possible causes for the cessation of menstruation. Secondary amenorrhea is indicated by the absence of periods for three to six months or longer after having had regular periods.

Amenorrhea is a sign, it is not, in itself, a disease and does not usually result from a serious condition. Suddenly missing a period and not knowing why can be a concern but it is best not to panic. Working together with the doctor, going over medical information, history and what is being experienced can usually solve the issue quite quickly. Symptoms, along with cessation of menstruation or not having had a period by the age of 16, can depend upon the cause. A milky discharge from the nipples, headache, vision changes, or excessive hair growth on the face and torso (hirsutism) can sometimes be associated symptoms.

Possible Causes of Primary Amenorrhea

Primary amenorrhea has some common causes associated with it. Certain chromosomal abnormalities can affect ovulation and menstruation. When chromosomes are affected, the eggs and follicles can deplete prematurely and periods don't start. A disorder of the hypothalamus - that part of the brain that acts as the control center for the body and regulates menses - can also cause periods to stop. Functional hypothalamic amenorrhea may be caused by excessive exercise, eating disorders, and physical or psychological stress. Sometimes a tumor can prevent the hypothalamus from functioning properly. Another gland in the brain involved in regulating menstruation is the pituitary gland. Pituitary disease, a tumor, or other invasive growth may interfere with the proper function of this gland. Problems can arise when a baby girl is born without some major reproductive organ, a result of something going awry during fetal development. Finally, structural abnormality of the vagina is another cause of primary amenorrhea. An obstruction of the vagina by a membrane or wall may prevent the out flowing of blood from the uterus and cervix.

Causes of Secondary Amenorrhea

Secondary amenorrhea has many possible causes including pregnancy, breast-feeding and the use of contraceptives. Stress often plays a big part in the cessation of menstruation and mental stress affects the hypothalamus, thus altering ovulation and menstruation. Certain medications, like antidepressants and antipsychotics as well as some chemotherapy drugs and oral corticosteriods may cause amenorrhea. Chronic illness, hormonal imbalance, and PCOS - which is associated with obesity, amenorrhea, acne and hirsutism are other causes. Low body weight interrupts hormonal functions and affects ovulation causing amenorrhea. Excessive exercise, thyroid malfunction (hypothyroidism), pituitary tumor, scar tissue buildup in the uterus (Asherman's syndrome) and premature menopause are also causes of secondary amenorrhea.

Even though amenorrhea rarely is the result of a condition that is life-threatening, it can and usually does involve a lot of hormonal disruption. A visit with the doctor is important to sort the issues out and deal with the underlying cause of amenorrhea. Often, when the underlying cause is dealt with, amenorrhea disappears.

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