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Amenorrhea, Definition, Symptoms, Causes, Diagnosis, Treatment, Prevention, Complications

Amenorrhea is a condition that refers to women who cannot menstruate. This situation can occur when a woman is 16 years old but has not experienced menstruation or commonly called primary amenorrhea. In addition, there is secondary amenorrhea, that is if a woman of childbearing age who is not pregnant, does not get menstruation again after 6 months of the last menstruation.

But this definition is still a debate in the medical community. Clinically, a 13-year-old woman who has not experienced signs of puberty such as breast growth and has not yet had menstruation is recommended to see a doctor. Similarly, women who have had menstruation, but do not get menstruation within 90 days of the last menstruation.

Amenorrhea, Definition, Symptoms, Causes, Diagnosis, Treatment, Prevention, Complications

Symptoms of Amenorrhea

Aside from not being able to menstruate, other symptoms that accompany it depend heavily on the cause of the amenorrhea itself. These symptoms are generally in the form of:

  • Headache.
  • Breasts do not enlarge.
  • Vision problems.
  • Excessive growth of facial hair.
  • Hair loss.
  • Severe sounds like men.
  • Acne.
  • The release of milk even if it is not breastfeeding, due to increased prolactin levels.
  • Pelvic pain.

Causes of Amenorrhea

Before discussing the causes of amenorrhea, please note that there are natural causes of non-menstruation, namely:

  • Pregnancy.
  • Breastfeeding.
  • Menopause.

Most of the causes of primary amenorrhea are when the ovaries do not produce or produce very little female s*x hormones, namely estrogen, and progesterone (hypogonadism). This happens in conditions, including:

Lack of the gonadotropin-releasing hormone (GnRH) hormone.

  • Eating disorders.
  • Failure to thrive.
  • Hypopituitarism.
  • Excess prolactin hormone.
  • Tumors in the brain.
  • Congenital adrenal hyperplasia.
  • Cushing's syndrome.

In addition to hypogonadism, primary amenorrhea can be caused by:

  • No uterine and vaginal formation, or cervix.
  • Androgen insensitivity syndrome.

For secondary amenorrhea, here are some conditions that can be the cause.

  • Use of contraception, especially injection KB.
  • Lifestyle, for example, a bodyweight that is too low, weight loss, excessive exercise, and stress.
  • Hormonal imbalances, such as in PCOS, hypothyroidism, tumors in the pituitary gland in the brain.
  • Anorexia.
  • Excess prolactin hormone.
  • Structural abnormalities of the reproductive organs, such as in Asherman's syndrome.
  • Primary ovarian insufficiency.
  • Ovarian tumors.
  • Cushing's syndrome.

Diagnosis of Amenorrhea

In addition to asking for the patient's symptoms and medical history, the doctor will do a physical examination, especially the examination around the pelvis. A number of advanced tests that can be performed by a doctor in amenorrhea patients are:

  • Pregnancy test. In women who are s*xually active, if you experience secondary amenorrhea, the first time the doctor will recommend is a pregnancy test.
  • Blood test. Aim to see abnormal hormone levels that may be the cause of amenorrhea, such as the hormone prolactin, estrogen, thyroid, follicle-stimulating hormone (FSH), dehydroepiandrosterone sulfate (DHEA-S), and testosterone.
  • Imaging. Ultrasound, CT scan, or MRI to see structural abnormalities in the reproductive organs, or if a tumor is suspected in the pituitary gland (pituitary).

Amenorrhea treatment

The treatment carried out depends on the cause of amenorrhea. Some of the treatment methods suggested by doctors are in accordance with the causes of amenorrhea, for example:

  • Treatment in women who have polycystic ovary syndrome (PCOS), treatment will focus on reducing the levels of androgen hormones.
  • Use of contraceptive pills or hormone drugs that trigger the menstrual cycle.
  • Estrogen hormone replacement therapy (estrogen replacement therapy / ERT) which helps stabilize hormones to trigger the menstrual cycle, in primary ovarian insufficiency conditions. ERT will replace estrogen not produced by the ovary to regulate the menstrual cycle normally. The doctor will also give a progestin or progesterone to reduce the risk of uterine cancer.
  • Amenorrhea caused by lifestyle factors can be handled by maintaining ideal body weight, controlling stress, and establishing a proper and regular exercise schedule.

Complications of Amenorrhea

Infertility is the most feared complication of amenorrhea. Another complication is due to low estrogen levels which cause reduced bone density or osteoporosis.
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