Description
Amenorrhea, the absence of menstruation, can be a challenging condition to diagnose and manage due to its diverse underlying causes. It is classified into primary amenorrhea, when menstruation has not started by age 15, and secondary amenorrhea, the cessation of menstruation in a woman who previously had regular cycles. Diagnosing amenorrhea requires a thorough evaluation, including a detailed medical history, physical examination, and appropriate laboratory tests to rule out conditions such as polycystic ovary syndrome (PCOS), thyroid dysfunction, hyperprolactinemia, or structural abnormalities of the reproductive system.
Résumé
- Amenorrhea is defined as the absence of menstruation. Primary amenorrhea is the lack of menstruation by age 15 or after three years from the onset of breast bud development. Secondary amenorrhea describes the absence of menstruation for more than three months in someone with regular cycles or six months in those with irregular cycles. The pathophysiology of menstruation is complex, involving the hypothalamus, pituitary, ovaries, and outflow tract, as well as other hormones like thyroid, prolactin, and cortisol.
- Diagnostic challenges include a multitude of potential causes, from hypothalamic issues due to stress or athletic activity to structural causes involving the uterus or vagina, endocrine disorders, and genetic or chromosomal abnormalities. Symptoms can be non-specific, such as weight changes, hirsutism, or acne, or even the simple report of a missed period. The onset and progress of amenorrhea can also vary, making diagnosis more complex.
- Investigations can range from basic hormonal panels to imaging studies like ultrasound and MRI, and even genetic testing, which can be expensive and inaccessible. Multiple coexisting conditions, as well as lifestyle and constitutional factors, further complicate the diagnostic process. A detailed history, including menstrual history, lifestyle factors, medication usage, and sexual development, is crucial.
- Physical examination should include height, weight, BMI, secondary sexual characteristics, thyroid examination, and signs of Turner's syndrome or androgen excess. Abdominal and pelvic examinations can reveal masses or structural abnormalities. Laboratory testing should include a urine pregnancy test, FSH and LH levels, thyroid function tests, prolactin levels, and potentially DHEA, serum estrogen, and cortisol levels.
- Treatment options include progesterone or estrogen-progesterone withdrawal to induce menstruation. Hormone replacement therapy is also used, particularly for those with constitutional delay or sexual development disorders, or in premature ovarian insufficiency to prevent bone complications and improve lipid parameters. Lifestyle adjustments and surgical management may also be necessary depending on the underlying cause.
Exemple de certificat
À propos des intervenants
Dr Yash Bahuguna
Gynécologue consultante, hôpitaux Indraprastha Apollo, New Delhi
Divulgation financière
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