Amenorrhea

Amenorrhea is the absence of menstruation. The term is applied when a woman who has previously menstruated misses three or more menstrual periods. It is also applied to young women who have not begun menstruation by the age of 15, whether or not they exhibit other signs of puberty.

What causes amenorrhea?

Amenorrhea can occur in females who are born with anatomical defects such as a missing uterus or vagina or incomplete formation of the reproductive organs. It is also related to a number of health conditions.Common causes of amenorrhea include:

• Polycystic ovary syndrome (PCOS)
• Ovarian failure
• Hypothalamic amenorrhea
• Hyperprolactinemia
• Pregnancy
• Uterine scarring
• Certain medications

Evaluation of amenorrhea

In addition to a history and physical examination, since pregnancy is a natural cause of secondary amenorrhea, your reproductive endocrinologist will rule this out as a cause prior to other testing.

Blood tests may be done to check the levels of estradiol, prolactin, follicle-stimulating hormone (FSH) and thyroid stimulating hormone (TSH).

Imaging tests such as ultrasound and MRIs may also be performed to rule out structural abnormalities or tumors. If a cause cannot be determined through the above tests, your fertility specialist may recommend hysteroscopy to evaluate the condition of the cervix and uterus.

Treatment of amenorrhea

Depending on the cause of amenorrhea, treatment options include hormonal therapy, surgery, medication, or lifestyle changes.

Unfortunately, when amenorrhea is due to premature ovarian failure, it eventually progresses to irreversible infertility. Hormonal therapy is recommended for patients with ovarian insufficiency that does not respond to treatment, since the condition can impact bone density. Women with PCOS may have a higher risk of diabetes and cardiovascular disease.