Amenorrhoea

Amenorrhea is the absence of menstruation (at least two cycles) in a woman during the period of sexual maturity. Physiological is amenorrhea during childhood, pregnancy, lactation and in the postmenopausal period.

Division according to age

1. Primary amenorrhea
   • if menarche does not occur before the age of 15;
   • causes - mainly organic - agenesis of the uterus, canalization disorder of the Müller ducts, hypoplasia of the parents;
   • chromosomal abnormalities leading to gonadal dysgenesis (30%), congenital developmental defects (19%), hypothalamohypophyseal insufficiency (17%), hyperprolactinemia (17%);
   • in a third it is genetics – dysgenesis of the gonads, etc.;
   • we have to differentiate between so-called cryptomenorrhea - endometrial shedding occurs, but is retained in the uterus or vagina, i.e. with hymenal closure (hematocolpos), with cervical closure (hematometra).
     
2. Secondary amenorrhea:
   • Missing menstruation for 3 months or longer in a woman who has been menstruating until now;
   • most common causes – secondary: hypothalamo-pituitary (61%), hyperprolactinemia (18%), ovarian disorders (9%), uterine disorders (5%)

Division of amenorrhea by cause

Hypothalamic amenorrhea

• Hypothalamic disorder is the most common cause of amennorrhoea.

1. Primary: due to CNS disease in childhood (encephalitis, meningitis), endocrinological syndromes (Fröhlich syndrome) – obesity, hypogonadism, gonadal dysgenesis.
2. Secondary: usually emotional, referred to as stress amenorrhea (was observed en masse during World War II in women prisoners), also after CNS diseases, after trauma, or part of psychiatric syndromes.

Pituitary amenorrhea

• Given pituitary insufficiency.

1. Primary – dwarfism, gigantism, tumors.
2. Secondary - postpartum necrosis (Sheehan's syndrome), Cushing's disease, etc.

Ovarian amenorrhea

1. Primary – Turner syndrome, Stein-Leventhal syndrome (polycystic ovary).
2. Secondary – hormonally active tumor (arrhenoblastoma) secreting androgens, conditions after ovariectomy.

Uterine amenorrhea

1. Primary – a consequence of uterine agenesis and some congenital developmental defects.
2. Secondary - Asherman's syndrome (symphysis of the uterine cavity - adhesions of the walls after inflammation or abrasion of the endometrium).

Amenorrhea from extragenital causes

• Part of various endocrinopathies (hyperplasia of the adrenal cortex, Addison's disease, hypo- and hyperthyroidism, severe forms of DM).

Diagnostics

1. Primary – we are looking for congenital developmental defects;
2. Secondary: replacement therapy:
   • we must rule out pregnancy;
   • careful anamnesis, examination of hormones (gonadotropins, estrogens, progesterone and prolactin), vaginal cytology, measurement of basal temperatures;
   • it is important to distinguish between central origin and peripheral origin - this is what functional tests are for.

Therapy

1. Primary: for central disorders – replacement therapy;
2. Secondary: replacement therapy;
   • if prolactin is elevated - we perform an MRI of the saddle, we administer bromocriptine or lisuride.

Links

Related Articles

• Cyclic bleeding disorders (Czech)
• Menstrual Cycles
• Cyclical changes in the female body
• Dysmenorrhea

Cited Literature

• ČECH, Evžen, et al. Porodnictví. 2. edition. Praha : Grada, 2006. ISBN 80-247-1303-9.

• Quadruplets of developed questions according to the study materials of J. Beneš, L. Mikšík, e-learning and the book Gynecology and Obstetrics (Martius 2005).