AMENORRHEA

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St.James’ College of Nursing, Chalakudy.

• Amenorrhea is the absence of menstrual
bleeding.
• Amenorrhea is a normal feature in prepubertal,
pregnant, and postmenopausal females. In
females of reproductive age, diagnosing
amenorrhea is a matter of first determining
whether pregnancy is the etiology.
• In the absence of pregnancy, the challenge is to
determine the exact cause of absent menses.

St.James’ College of Nursing, Chalakudy.

Types
• Primary amenorrhea

Primary amenohorrea is when periods do not start during

puberty.

Primary Amenorrhea is defined either as absence of menses by

age 14 years with no development of secondary sexual
characteristics OR as absence of menses by age 16 years with
normal development of secondary sexual characteristics.

St.James’ College of Nursing, Chalakudy.

• Secondary amenorrhea

Secondary amenorrhea is defined as the

cessation of menstruation for at least 6 months
or for at least 3 of the previous 3 cycle intervals

St.James’ College of Nursing, Chalakudy.

• Primary amenorrhea
• A common cause of primary amenorrhea is a family history
of delayed menstruation. sometimes there is a genetic
problem.
• Genetic conditions that can stop the ovaries from working
properly include:
• Turner syndrome
• androgen insensitivity syndrome which leads to high levels
of testosterone
• Müllerian defects: A Müllerian defect is a malformation of
the reproductive organs.

St.James’ College of Nursing, Chalakudy.

Secondary amenorrhea

• Menstruation may stop due to

• a gynecological disorder
• serious illness
• physical stress
• having a very low body mass index (BMI)
• When BMI falls below 19, the risk of
developing secondary amenorrhea increases
significantly.

St.James’ College of Nursing, Chalakudy.

• Medications
• Some medications, such as progesterone-only
contraceptives and a number of psychiatric drugs may
cause periods to stop.
• Other medications that affect menstruation include:
• Antipsychotics
• Cancer chemotherapy
• Antidepressants
• Blood pressure drugs
• Allergy medications

St.James’ College of Nursing, Chalakudy.

• Long-term health conditions
• Amenorrhea can also result from a long-term
illness, such as:
• polycystic ovary syndrome (PCOS)
• premature ovarian failure
• thalamic pituitary problems
These could be due to:
• a benign or cancerous tumor in the pituitary gland
or under-active thyroid gland

St.James’ College of Nursing, Chalakudy.

• Symptoms
• The main symptom is a lack of menstruation.
• However, depending on the cause, other symptoms may
occur.
• These include:
• milky nipple discharge
• hair loss
• a headache
• vision changes
• additional facial hair

St.James’ College of Nursing, Chalakudy.

• Diagnosis
• Amenorrhea is a symptom, not an illness
• Primary amenorrhea
• If an individual has not started menstruating by the age of 16
years, a doctor may ask about their family history and carry out
a number of tests.
• These will include:
• follicle stimulating hormone (FSH)
• luteinizing hormone (LH)
• thyroid stimulating hormone (TSH)
• also physical examination.

St.James’ College of Nursing, Chalakudy.

• Secondary amenorrhea
• A diagnosis for secondary amenorrhea will focus on the underlying
cause of the problem.
• Before carrying out any tests, the physician may ask questions to
find out:at what age menstruation started
• whether the person is sexually active if pregnancy is a possibility
• if weight loss or weight gain has occurred, and what kind of
exercise routine the person follows
• the length and regularity of the menstrual cycle and whether
bleeding is heavy or light
• They may then recommend a number of tests, depending on what
the cause appears to be.

St.James’ College of Nursing, Chalakudy.

• These may include:
• a pregnancy test
• a thyroid function test
• ovary function test
• androgen and other hormone tests

St.James’ College of Nursing, Chalakudy.

• Imaging tests may include:

• MRI, CT, or ultrasound scan

• a hysteroscopy, in which the doctor passes a thin,

lighted camera through the vagina and cervix to
examine the uterus from the inside

St.James’ College of Nursing, Chalakudy.

• Treatment will depend on the cause.
• Primary amenorrhea
• Treatment for primary amenorrhea may start with
watchful waiting, depending on the person’s age and
the result of the ovary function test. If there is a
family history of late menstruation, periods may
start in time.
• If there are genetic or physical problems that involve
the reproductive organs, surgery may be necessary.

St.James’ College of Nursing, Chalakudy.

Treatment
• Secondary amenorrhea
• This will depend on the underlying cause.
• Lifestyle factors: If the person has been
exercising excessively, a change of exercise
plan or diet may help to stabilize the monthly
cycle.
• Stress: If emotional or mental stress is a
problem, counseling may help

St.James’ College of Nursing, Chalakudy.

• Excessive weight loss:
• Underactive thyroid: If menstruation stops
because of an underactive thyroid, the doctor
may prescribe treatment with thyroxine, a
thyroid hormone.

St.James’ College of Nursing, Chalakudy.

• Polycystic ovary syndrome (PCOS): The doctor
will suggest appropriate treatment. If PCOS has
led to excess weight, they may recommend a
weight-loss diet.
• Premature ovary failure: Hormone replacement
therapy (HRT) may cause menstruation to return.
• Menopause: Menopause starts around the age of
50 years, but sometimes it can start as early as 40
years. Family history can affect this.

St.James’ College of Nursing, Chalakudy.

St.James’ College of Nursing, Chalakudy.
St.James’ College of Nursing, Chalakudy.