Amenorrhoea

Definition | Aetiology | Types of Amenorrhoea | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Amenorrhoea is the absence of menstruation in a woman of reproductive age. It can be classified into two types: primary amenorrhoea (where a woman has not had her first period by the age of 16) and secondary amenorrhoea (where a woman who previously had regular periods stops menstruating for three or more consecutive months).

Aetiology

The causes of amenorrhoea can be divided into primary and secondary causes:

• Primary Amenorrhoea: Often caused by genetic or anatomical abnormalities, such as Turner syndrome, androgen insensitivity syndrome, or congenital absence of the uterus or vagina. Other causes include chronic illnesses or conditions that delay puberty.
• Secondary Amenorrhoea: Can result from a variety of factors including pregnancy, polycystic ovary syndrome (PCOS), hypothalamic amenorrhoea (often due to stress, excessive exercise, or significant weight loss), hyperprolactinaemia, thyroid disorders, or premature ovarian insufficiency.

Types of Amenorrhoea

• Primary Amenorrhoea: Absence of menarche by age 16, often due to genetic, endocrine, or structural abnormalities.
• Secondary Amenorrhoea: Cessation of menstruation for three or more consecutive months in a woman who previously had regular menstrual cycles.

Risk Factors

• Family history of amenorrhoea or reproductive disorders.
• Excessive physical exercise or low body weight.
• Stress or significant psychological factors.
• Chronic medical conditions (e.g., diabetes, celiac disease).
• Use of certain medications, including antipsychotics and chemotherapy drugs.
• Polycystic ovary syndrome (PCOS) or other hormonal imbalances.

Signs and Symptoms

• Absence of menstrual periods.
• Possible symptoms related to underlying causes, such as weight changes, acne, hirsutism, or galactorrhoea.
• Infertility or difficulty conceiving.
• Vaginal dryness or atrophic changes.

Investigations

• Pregnancy Test: Rule out pregnancy as a cause of secondary amenorrhoea.
• Hormonal Testing: Measure levels of FSH, LH, prolactin, TSH, and estradiol to evaluate for hormonal imbalances.
• Imaging: Pelvic ultrasound to assess for structural abnormalities or polycystic ovaries.
• Genetic Testing: Consider in cases of primary amenorrhoea, particularly if Turner syndrome or other genetic conditions are suspected.

Management

• Treat Underlying Causes: Management of amenorrhoea involves addressing the underlying cause. This may include:
  • Weight management and nutritional support for hypothalamic amenorrhoea.
  • Hormonal treatments, such as the use of oral contraceptives or hormone replacement therapy (HRT), for hormonal imbalances.
  • Medications to treat underlying conditions, such as metformin for PCOS or levothyroxine for hypothyroidism.
  • Psychological support or therapy for stress-related amenorrhoea.
• Fertility Treatment: Referral to a fertility specialist if amenorrhoea is associated with infertility and the woman desires pregnancy.
• Surgical Intervention: May be necessary for structural causes, such as uterine abnormalities or imperforate hymen.
• Patient Education: Provide information on the condition, treatment options, and potential long-term effects, including impacts on bone health due to oestrogen deficiency.

References

1. NHS (2024) Amenorrhoea. Available at: https://www.nhs.uk/conditions/amenorrhoea/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Amenorrhoea: Management and Outcomes. Available at: https://cks.nice.org.uk/topics/amenorrhoea/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Amenorrhoea: Diagnosis and Management. Available at: https://www.bmj.com/content/350/bmj.h392 (Accessed: 24 June 2024).

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