The first menstrual bleeding in women occurs on average at the age of 12 years. During the menstruation period, the uterus renews itself and expels it from the vagina. This process continues for 2 to 5 days and prepares its inner surface for pregnancy. If pregnancy does not occur, it enters the menstrual period again and continues the cycle. This situation repeats during the fertile period and the preparation of the uterus ends with the menopause and menstruation is interrupted. The absence or cessation of these bleeding is called amenorrhea.
What is Amenorrhea?
Some situations should occur in people who will have a period for the first time. These are the uterus and genital tracts should be healthy, the endometrium layer should be functional, the ovaries should be healthy and functional, the hypothalamus and pituitary should be healthy, and all these 4 compartments should be working properly. When all these conditions are met, the first menstruation is expected between the ages of 9 and 18 and, on average, at the age of 12. This condition, which is called secondary sex character development until the age of 14, is called primary amenorrhea, which is found in people without breast development and hair growth, or in people who have started secondary sex character development but have never had a period even though they are at the age of 16. Secondary amenorrhea, on the other hand, is when people who have menstruated before do not menstruate for 3 consecutive months in periods other than menopause and pregnancy.
What is primary amenorrhea?
98% of people who reach the age of 15 have a period. If menstruation is not observed in people who do not reach sufficient maturity around this age, it is necessary to apply the necessary tests with the suspicion of primary amenorrhea and consult a physician for a definitive diagnosis and treatment. Congenital anomalies, hormonal disorders, absence of uterus and vagina, failure of reproductive organs, chromosome abnormalities may cause primary amenorrhea. In order for a person to have a period, all 4 different compartments must work in order and harmony.
Primary causes of amenorrhea
• Compartment; Uterus and vagina: It is amenorrhea that develops as a result of developmental disorders known as Müllerian agenesis. In this case, where there is no genetic transition, although the ovarian function is normal, the uterus, tubes and upper part of the vagina are not found. However, there may be a rudimentary uterus, that is, an undeveloped uterus. In some cases, urinary, vertebral, skeletal system and system anomalies can be seen. Due to previous abortion operations called Asherman syndrome, intrauterine adhesions can also be seen in people who are genetically male but whose external appearance is female as a result of genetic disorders called androgen insensitivity. Second, it is the most common primary cause of amenorrhea. Ultrasound, MRI, laparoscopic and vaginoscopic methods can be used for diagnosis.
• Compartment; Ovaries: Turner syndrome, known as a person having 45 chromosomes instead of 46, is the most common cause of primary amenorrhea. It is generally characterized by short stature, low hairline, high arched palate, mane neck. The primary causes of amenorrhea are gonadal agenesis or Swyer syndrome in which there is no ovarian development, the presence of an ovarian resistant to hormones, premature ovarian failure defined as premature ovarian failure, and loss of functionality of the ovaries due to radiation and chemotherapy treatments. It can be hereditary or acquired.
• Compartment; Pituitary: Injuries to the pituitary gland located in the skull after trauma, tumor or surgical intervention are among the primary causes of amenorrhea. Generally, families consult a physician as a result of delay in growth and sexual development. Hormonal order disrupted by the tumor in the pituitary gland; It is the formation of primary amenorrhea caused by problems in the 3rd compartment in cases such as milk coming from the breasts due to excessive secretion of the milk secretion hormone known as prolactin, Sheehan syndrome that develops due to postpartum hemorrhage.
• Compartment; Hypothalamus: Secondary sex character development is not seen in people with complete GnRH deficiency. In case of partial deficiency, there are different levels of secondary sex character development. Pulsatile release disorders include psychological stress, excessive weight gain and loss, nutritional disorders, anorexia, and excessive exercise. In anorexia nervosa, excessive attention to body shape, fear of gaining weight, excessive normal weight, consuming food by excessive restriction are found. In addition to all these factors, immunodeficiency and chronic diseases constitute the 4th compartment.
What is secondary amenorrhea?
All compartments work normally in women with regular menstruation. The hypothalamus and pituitary hormonal secretions in the brain stimulate the ovaries and enable the ovaries to secrete estrogen and progesterone. These secreted hormones stimulate the inner layer of the uterus, called the endometrium, and initiate menstruation. In order for this whole system to work properly, all mechanisms must work normally. Thus, regular menstruation occurs. Secondary amenorrhea is the absence of menstruation for 3 consecutive months, except during pregnancy, menopause and breastfeeding. This complaint is seen in 2% to 5% of women in the society.
Secondary causes of amenorrhea
Generally, the biggest cause is pregnancy. However, the use of many drugs such as cortisone use, depression, chemotherapy, steroids, and birth control drugs can cause the disruption or cessation of the menstrual cycle.
• Hormonal disorders
• Thyroid diseases
• Pituitary gland diseases and tumor
• Unbalanced and unhealthy diet
• Sudden and excessive weight gain or loss
• Bulimia nervosa
• Extreme sport
• Cystic fibrosis
• Asherman syndrome
• Polycystic Ovary Syndrome
• Cushing Syndrome
• Psychological traumas, depression and stress
• Uterine injury
• Drug use
What are the symptoms of amenorrhea?
• Cessation of menstruation or absence of menstruation
• Milk coming from the breast
• Headache and / or visual disturbances
• Excessive hair growth and acne
• Pelvic pain
Amenorrhea diagnosis and treatment
For the treatment of primary amenorrhea, the history, somatic growth and sexual development history, the presence of metabolic disease or chromosome anomaly in the patient or family are questioned first to clarify the diagnosis. Nutrition pattern, weight status, sports history, psychological status and stress status are examined. After the body mass index is examined, genital examination, breast and hair growth are examined. It is diagnosed as a result of laboratory tests and radiological examinations. After the compartment causing the disease is identified, a multidisciplinary targeted treatment is applied. These treatments can be applied with medication or surgery. Some of the primary amenorrhea cases that develop due to congenital abnormalities are corrected by surgery. If it is related to the tumor in the pituitary, medication, radio therapy and surgical intervention may be required. If it is caused by hormonal disorders, drug treatment is caused by other diseases and drugs used, drug use is stopped and the existing disease is treated. In secondary amenorrhea, as in primary amenorrhea, pregnancy should be ruled out first. Nutritional status, weight status, sports history, stress and psychological status, as well as the absence of anatomical disorders in the uterus, cervix and vagina are examined. After checking hormone levels with laboratory tests, radiological imaging is performed for the pituitary gland and its abnormalities. After determining the compartment that causes secondary amenorrhea, diet application, regulation of medication use, medication, radiological or surgical treatment are applied as in primary amenorrhea. Do not neglect to have regular check-ups for early diagnosis and a healthy life.