Amenorrhoea

Amenorrhoea (absense of periods), a failure to have periods, which may be described as primary and secondary. Primary Amenorrhoea is the failure to mentruate by age 16 and the main cause is the late onset of puberty. A girl may have the other signs of puberty (breast development, underarm and pubic hair, growth spurt) but lack periods. This may be because of a pituitary tumor, which can be found via a skull X-ray or because of cryptomenorrhoea where menstrual bleeding does occur but it is held inside the vagina by an obstruction such as imperforate hymen.

Rarely the condition may arise because parts of the female reproductive system for example ovaries, uterus, vagina, are missing. The most common reason for the primary Amenorrhoea is disruption of the relationship between the ovaries and the pitutary glands. Puberty may be delayed as a girl needs to reach a critical weight before the body triggers menstruation. Many disorders may affect the pitutary, ovary, thyroid and adrenal glands, causing hormonal imbalance.

Nutritional problems such as Anorexia Nervosa or Obesity can cause primary amenorrhoea, as can Diabetes, Crohn's disease, Heart Disease, tuberculosis and various drugs.

Secondary amenorrhoea occurs when a woman stops menstruating for 3 months or more after normal menstrual periods have been established but before the onset of the menopause. The most common cause is pregnancy, but it may also arise because of Anorexia Nervosa, excessive dieting, Polycystic Ovarian Syndrome, cysts and tumors. It can develop for the same reasons as primary amenorrhoea. It may also arise as a result of stress, chronic diseases, e.g. thyroid disease, Anaemia, damage to the pituitary gland, haemorrhage in childbirth, shock, extreme weight loss and/or excessive physical activity (in athletes), and taking certain drugs, especially tranquillizers and antidepressants. Stopping the contraceptive pill, which affects hormone production in the brain, can cause amenorrhoea for up to a year, and it may arise after childbirth and breast-feeding.

Failure of the ovaries, prompting a premature menopause before the age of 40, is another cause. Occasionally the ovaries fail for a time but can become active again, restoring menstruation. Amenorrhoea is permanent after the menopause or if the uterus is removed in a hysterectomy.

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