Amenorrhea Causes – absence of menstrual cycle
- non-occurrence of the first menstrual cycle after age 16 (does not matter if there are secondary sexual characters). In this case it is called primary amenorrhea.
- absence of a menstrual cycle more than six months in women who had menstruation before. In this case it is called secondary amenorrhea.
Causes of amenorrhea (primary or secondary): anatomical defects, ovarian insufficiency, chronic anovulation.
1. Anatomical defects of the vagina, unperforated hymen, the existence of a transverse vaginal septum, cervical obstruction (stenosis ), adhesions in uterus, absence of vagina or uterus, uterus underdevelopment. To diagnose such an anatomical defect it is made a physical exam and is confirmed by the absence of bleeding after 3 weeks of therapy with estrogen and progesterone. Imaging confirmation is done by: ultrasound, MRI (magnetic resonance imaging), hysterosalpingography, hysteroscopy.
2. Ovarian insufficiency. The causes of ovarian insufficiency: gonads dysgenesis, P45017alfa deficiency, resistant ovary, early ovarian insufficiency, a disease characterized by ovarian germ cell deficiency (or in which the germ cells are resistant to follicle stimulating hormone). To confirm ovarian insufficiency it will be determined the amount of FSH (follicle stimulating hormone ), which should be increased.
3. Chronic anovulation. This condition is defined by the absence of spontaneous ovulation, but the presence of ovulation after appropriate treatment. In some cases, the secretion of estrogen is sufficient, but it is not cyclical. In some cases the secretion of estrogen is low. The polycystic ovaries disease is characterized by: normal production of estrogen and bleeding after progesterone therapy. Tumors of the ovary and adrenal glands that secrete hormones are other possible causes of anovulation
Hypogonadotrophic hypogonadism (deficient gonadotropic hormones FSH, LH): estrogen deficiency, absence of bleeding after administration of progesterone. Problems are due to pituitary gland or central nervous system (functional or organic problems ): tumors , hypopituitarism , Sheehan syndrome.