Citizendia

Amenorrhoea
Classification and external resources
ICD-10 N91.0-N91.2
ICD-9 626.0

Amenorrhoea (BE), amenorrhea (AmE), or amenorrhœa, is the absence of a menstrual period in a woman of reproductive age. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings N00-N39 - Diseases of the Genitourinary system: urinary system (N00-N08 Glomerular diseases Prefixes. N00-N39 - Diseases of the Genitourinary system: urinary system (N00-N08 Glomerular diseases Prefixes. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. British English or UK English ( BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the Phonology North American English regional phonology In many ways compared to English English, North American English is conservative in its Phonology. The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the Physiologic states of amenorrhoea are seen during pregnancy and lactation (breastfeeding), the latter also forming the basis of a form of contraception known as the lactational amenorrhea method. Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female Breastfeeding is the feeding of an Infant or young Child with Breast milk directly from human Breasts, not from a Baby bottle or other The lactational amenorrhea method (LAM is a method of avoiding pregnancies which is based on the natural Postpartum infertility that occurs when a woman is amenorrheic Outside of the reproductive years there is absence of menses during childhood and after menopause. Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan

Amenorrhoea is a symptom with many potential causes. Primary amenorrhoea (menstruation cycles never starting) may be caused by developmental problems such as the congenital absence of the uterus, or failure of the ovary to receive or maintain egg cells. "Ovaria" redirects here This is also a proposed section and a Synonym of Solanum. An ovum (plural ova) is a Haploid Female reproductive cell or Gamete. Also, delay in pubertal development will lead to primary amenorrhoea. Secondary amenorrhoea (menstruation cycles ceasing) is often caused by hormonal disturbances from the hypothalamus and the pituitary gland or from premature menopause, or intrauterine scar formation. The hypothalamus links the Nervous system to the Endocrine system via the Pituitary gland (hypophysis The pituitary gland, or hypophysis, is an Endocrine gland about the size of a Pea. Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan

Contents

Etymology and history

The term is derived from Greek: a = negative, men = month, rhoia = flow. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly Derived adjectives are amenorrhoeal and amenorrheic. The opposite is the normal menstrual period. The menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive-age Females Overt menstruation (where there is blood flow from the

Classification of amenorrhoea

Types of amenorrhoea is diagnosed based on several factors which include the age of onset, and level of hormonal involvement.

Age of onset

There are two types of amenorrhea: primary and secondary amenorrhea. Primary amenorrhoea is the absence of menstruation in a woman by the age of 16. Also, as pubertal changes precede the first period, menarche, women who have no sign of thelarche or pubarche and thus are without evidence of initiation of puberty by the age of 14 have primary amenorrhoea. Menarche (American English məˈnɑrki British English mɛˈnɑːki is the first menstrual period, or first menstrual bleeding in the females of Human beings Thelarche is the first stage of secondary (postnatal Breast development usually occurring at the beginning of Puberty in girls Pubarche refers to the first appearance of Pubic hair in a child (Reference: Speroff L et al, Clinical Gynecologic Endocrinology and Infertility, 1999)

Secondary amenorrhoea is where an established menstruation has ceased - for three months in a woman with a history of regular cyclic bleeding, or six months in a woman with a history of irregular periods. This usually happens to woman aged 40-45. Amenorrhoea may cause serious pain in the back near the pelvis and spine. This pain has no cure but can be relieved by doses of progesterone. Progesterone will also help the bleeding or dark colored urine from a woman's vagina.

Primary amenorrhoea

  1. Gonadal dysgenesis, including Turner Syndrome. Turner syndrome or Ullrich-Turner syndrome encompasses several conditions of which monosomy X is the most common
  2. Mullerian agenesis (Mayer-von-Rokitansky-Küster-Hauser syndrome (MRKH)).
  3. Androgen insensitivity syndrome. Androgen insensitivity syndrome (AIS also referred to as androgen resistance syndrome, is a set of disorders of Sexual differentiation caused by Mutations
  4. Delay in hypothalamic-pituitary maturation.
  5. Olfacto-genital dysplasia, Kallmann syndrome. Kallmann syndrome is an example of Hypogonadism (decreased functioning of the sex hormone-producing glands caused by a deficiency of Gonadotropin-releasing hormone
  6. Vaginal obstruction, cryptomenorrhea, imperforate hymen. Cryptomenorrhea is a condition where Menstruation occurs but is not visible due to an obstruction of the outflow tract The hymen (also called maidenhead) is a fold of Mucous membrane which surrounds or partially covers the external Vaginal opening
  7. Receptor abnormalities for FSH, LH.
  8. Specific forms of congenital adrenal hyperplasia
  9. Swyer syndrome
  10. Galactosemia
  11. Aromatase deficiency
  12. Prader-Willi syndrome
  13. Male pseudo-hermaphroditism (about 1 in every 150,000 births)
  14. Other intersexed conditions

Secondary amenorrhoea

  1. Pregnancy
  2. Anovulation
  3. Menopause
  4. Premature menopause
  5. Hypothalamic-pituitary dysfunction, including
    1. Exercise amenorrhoea, related to excessive physical exercise
    2. Stress amenorrhoea,
    3. Eating disorders and weight loss (obesity, anorexia nervosa, or bulimia)
  6. Hyperprolactinemia (elevated prolactin levels)
  7. Polycystic ovary syndrome (PCO-S)
  8. Androgen producing tumor (i. Congenital adrenal hyperplasia ( CAH) refers to any of several Autosomal Recessive Diseases resulting from Mutations Swyer syndrome, or XY gonadal dysgenesis, is a type of Hypogonadism in which no functional Gonads are present to induce Puberty in an externally Galactosemia is a rare genetic metabolic disorder which affects an individual's ability to properly metabolize the sugar Galactose. Prader-Willi syndrome (abbreviated PWS) is a very rare Genetic disorder, in which seven genes (or some subset thereof on chromosome 15 are missing or unexpressed A hermaphrodite is an organism having both male and female reproductive organs Intersexuality is the state of a living thing of a gonochoristic species whose Sex chromosomes, Genitalia, and/or Secondary sex characteristics Pregnancy ( Latin graviditas) is the carrying of one or more offspring known as a Fetus or Embryo, inside the Uterus of a Female An anovulatory cycle is a cycle during which the ovaries fail to release an oocyte Menopause is the permanent shutting down of the female Reproductive system, a considerable length of time before the end of the lifespan Premature Ovarian Failure (POF also known as primary ovarian insufficiency, is the loss of function of the Ovaries before age 40 Hypopituitarism is the decreased ( hypo) secretion of one or more of the eight Hormones normally produced by the Pituitary gland at the base of the Brain An eating disorder is a compulsion to eat or avoid eating that negatively affects both one's physical and mental health Anorexia Nervosa is a psychiatric Diagnosis that describes an Eating disorder characterized by low Body weight and Body image distortion Bulimia nervosa is an Eating disorder characterized by recurrent Binge eating, followed by compensatory behaviors referred to as "purging" Hyperprolactinaemia ( BrE) or hyperprolactinemia ( AmE) is the presence of abnormally-high levels of Prolactin in the blood Prolactin ( PRL) or Luteotropic hormone ( LTH) is a Peptide hormone primarily associated with Lactation. Polycystic ovary syndrome abbreviated PCOS or PCO (also known clinically as Stein-Leventhal syndrome, Sclerocystic ovary syndrome, Hyperthecosis e arrhenoblastoma)
  9. Intrauterine adhesions (Asherman's Syndrome)
  10. Thyroid dysfunction
  11. Hemochromatosis
  12. Drug-induced

Hormonal involvement

Hypogonadotropic amenorrhoea refers to conditions where there are very low levels of serum FSH and LH. Sertoli-Leydig cell tumour, also known as arrhenoblastoma or androblastoma, is a member of the Sex cord-stromal tumour group of ovarian and Asherman's syndrome, also called "uterine Synechiae quot or intrauterine Adhesions, presents a condition characterized by the presence of scars within the uterine The thyroid is one of the largest Endocrine glands in the body Haemochromatosis, also spelled hemochromatosis (see spelling differences) also called siderophilia Generally, inadequate levels of these hormones lead to inadequately stimulated ovaries who then fail to produce enough estrogen to stimulate the endometrium (uterine lining), hence amenorrhoea. Estrogens (US otherwise oestrogens or œstrogens) are a group of Steroid compounds named for their importance in the Estrous cycle, The endometrium is the inner membrane of the Mammalian Uterus. This is typical for conditions of pubertal delay, hypothalamic or pituitary dysfunction. In general, women with hypogonadotropic amenorrhoea are potentially fertile.

Hypergonadotropic amenorrhoea refers to conditions with high levels of FSH (and LH). FSH levels are typically in the menopausal range. This implies that the ovary or gonad does not respond to pituitary stimulation. "Ovaria" redirects here This is also a proposed section and a Synonym of Solanum. The gonad is the organ that makes Gametes The gonads in males are the Testes and the gonads in Females are the Ovaries. Gonadal dysgenesis or premature menopause are possible causes. Chromosome testing is usually indicated in younger individuals with hypergonadotropic amenorrhoea. A chromosome is an organized structure of DNA and Protein that is found in cells.

In normogonadotropic amenorrhoea, FSH levels are in the normal range. This would suggest that the hypothalamic-pituitary-ovarian axis is functional. Amenorrhoea may be due to outflow obstruction, or abnormal ovarian regulation or excess androgens as seen in polycystic ovary syndrome.

Cushing's Disease/Syndrome can also cause amenorrhoea due to excessive amounts of cortisol in the blood stream.

Specific types of amenorrhoea

Exercise amenorrhoea

Female athletes or women who perform considerable amounts of exercise on a regular basis are at risk of developing 'athletic' amenorrhoea. It was thought for many years that low body fat levels and exercise related chemicals (such as beta endorphins and catecholamines) disrupt the interplay of the sex hormones estrogen and progesterone. However recent studies have shown that there are no differences in the body composition, or hormonal levels in amenorrheic athletes. Instead, amenorrhea has been shown to be directly attributable to a low energy availability. Many women who exercise at a high level do not take in enough calories to expend on their exercise as well as to maintain their normal menstrual cycles. [1]

A second serious risk factor of amenorrhea is severe bone loss sometimes resulting in osteoporosis and osteopenia. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Osteopenia is a condition where Bone mineral density is lower than normal It is the third component of an increasingly common disease known as female athlete triad syndrome. The female athlete triad is a Medical condition seen in Female Athletes characterized by the interplay between three different disorders low energy availability The other two components of this syndrome are osteoporosis and disordered eating. Osteoporosis is a Disease of Bone that leads to an increased risk of fracture. Disordered eating is a term that is used by some people to describe a wide variety of irregularities in eating behavior that do not warrant a diagnosis of a specific Eating disorder Awareness and intervention can usually prevent this occurrence in most female athletes. In Biological psychology, awareness comprises a human's or an animal's perception and Cognitive reaction to a condition or event

High risk sports

Drug-induced amenorrhea

Certain medications, particularly contraceptive medications, can induce amenorrhoea in a healthy woman. The lack of menstruation usually begins shortly after beginning the medication and can take up to a year to resume after stopping a medication. Hormonal contraceptives that contain only progestogen like the oral contraceptive Micronor, and especially higher-dose formulations like the injectable Depo Provera commonly induce this side-effect. Progestogen Only Pills or Progestin Only Pills ( POP) are Contraceptive Pills that only contain synthetic Progestogens ( Progestins Depot medroxyprogesterone acetate ( DMPA) is a Progestin -only hormonal contraceptive Birth control drug which is injected every 3 months Side Effect were an influential Disco band that recorded between 1972 and 1995 Recently, an extended cycle combined oral contraceptive pill which aims to purposefully induce amenorrhea (Lybrel), has been approved by the FDA. Extended cycle combined oral contraceptive pills are COCPs packaged to reduce or eliminate the withdrawal bleeding that occurs once every 28 days in traditionally packaged COCPs

Treatments

Treatments vary based on the underlying condition. Key issues are problems of surgical correction if appropriate and estrogen therapy if estrogen levels are low.

For those who do not plan to have biological children, treatment may be unnecessary if the underlying cause of the amenorrhoea is not threatening to her health.

Unless receiving eggs from an egg donor or invetro fertilization, a woman is unable to conceive while she is amenorrhoeic. Egg donation is the process by which a woman provides one or several eggs ( Ova, oocytes for purposes of assisted reproduction or biomedical research On the other hand, 'athletic' and drug-induced amenorrhoea has no effect on long term fertility as long as menstruation can recommence. The best way to treat 'athletic' amenorrhoea is to decrease the amount and intensity of exercise. Similarly, to treat drug-induced amenorrhoea, stopping the medication on the advice of a doctor is a usual course of action.

External links

Dictionary

amenorrhoea

-noun

  1. (medicine) Absence of menstrual discharge.
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