With the puberty period in healthy women, an egg cell matures in the ovaries every month and the menstrual cycle begins. With the start of this cycle, menstrual bleeding occurs every month, and this continues until the loss of reproductive ability with menopause at the age of about 45-55 years. Absence of menstruation is called amenorrhea, although there is no pregnancy, lactation, or onset of menopause in women of reproductive age. In amenorrhea, which can be confused with menstrual irregularity, there is not any irregularity, but the problem of not having a period at all. Although amenorrhea cannot be directly characterized as a disease, it may arise from a disease that requires intervention or may cause problems for women who want to have a baby. For this reason, women with amenorrhea complaints should be examined by consulting gynecology specialists, and should be treated if a problem requiring intervention is detected as a result of the physician's evaluations.
What is Amenorrhea?
It is the absence of menstruation even though she has entered puberty or has not yet entered menopause. An alternative answer to the question of what amenorrhea means is the absence of menstruation or the absence of menstruation, which is seen in women who are not pregnant, not breastfeeding and in the post-adolescent, pre-menopausal period.
Amenorrhea is divided into two groups as primary and secondary, depending on the absence of menstruation or the cessation of menstruation after menstruation. Although primary or secondary amenorrhea is usually caused by hormonal problems, it can be caused by different causes such as anatomical problems, gynecological diseases and benign or malignant cysts. In some cases, women who do not have any gynecological disease, no problems with body anatomy and who have normal hormone levels may also have the problem of non-menstruation.
What is Primary Amenorrhea?
Primary amenorrhea is the condition of not having menstruation yet in young girls despite the completion of 15-16 years of age. In this case, menstrual bleeding does not start during adolescence and primary amenorrhea is suspected. In people who are 15 years old and still have not had a menstrual period, necessary examinations and tests should be done to see if there is any health problem that may underlie this situation. H Hormonal disorders are the most common cause of primary amenorrhoea.
However, congenital anomalies, chromosomal disorders, presence of anatomical problems such as absence of uterus and vagina, and underdevelopment of reproductive organs may cause primary amenorrhea. Some problems related to the pituitary gland or hypothalamus, which affect the synthesis of hormones necessary for the onset of menstrual bleeding, other than the reproductive organs, are also among the causes of primary amenorrhea, and detailed research on the cause of this condition should be carried out for treatment.
In some people, the hymen at the entrance of the vagina may not anatomically contain holes to allow menstrual blood to come out and may have completely closed the vaginal tract. In this case, menstrual bleeding accumulates in the vagina and causes serious health problems. When the necessary opening is created on the hymen with the help of a simple operation, menstruation begins and continues in a healthy way.
What is Secondary Amenorrhea?
Secondary amenorrhea, unlike primary amenorrhea, despite having menstruation before It is the condition of not having menstruation afterwards. Gynecological diseases, acute or chronic serious diseases, intense stress, extreme weakness, rapid weight loss, intense exercise, unhealthy diet, pituitary gland diseases or some medications are among the common causes of secondary amenorrhea.
The fact that the body mass index, which is obtained when the value of body mass in kilograms is divided by the square of the value in meters of height, is below 19, significantly increases the probability of secondary amenorrhea. Gynecological diseases such as polycystic ovary syndrome, ovarian and endometrial cysts, premature ovarian failure are among some gynecological diseases that can cause cessation of menstruation. Thyroid diseases can also prevent menstruation by affecting the hormonal balance.
In addition, chemotherapy drugs, antipsychotic and antidepressant drugs, some blood pressure and allergy drugs can also cause secondary amenorrhea. Absence of menstruation is normal in mothers who are breastfeeding due to the suppressive effect of prolactin hormone on ovulation and this situation is not considered as amenorrhea. In women with active sexual life, amenorrhea should be suspected. A pregnancy test should be done before starting any further research.
What are the Symptoms of Amenorrhea?
The main symptom of amenorrhea is the absence of menstrual bleeding. However, various additional symptoms can be seen with the effect of the problem that causes amenorrhea. Although these symptoms may differ depending on the underlying health condition, they commonly include:
- Hairing (hirsutism)
- Headache
- Visual disturbances
- Milk or discharge from the nipple
- Pelvic pains
- Acne
- Hair loss
- Absence of breast development (in primary amenorrhea) These symptoms, which can be seen in addition to amenorrhea, can give important ideas about the health problem that prevents menstruation. For this reason, it is beneficial for patients who apply to health institutions for the treatment of amenorrhea to inform their physicians about the additional symptoms they experience.
How to Treat Amenorrhea?
The process for the treatment of amenorrhea should start with a definitive diagnosis. For this, first of all, a pregnancy test is done to rule out the possibility of pregnancy. With a gynecological examination performed by the physician, the vagina, uterus and ovaries can be examined in detail under ultrasound guidance. In secondary amenorrhoea, detailed information can be obtained with vaginal ultrasound in women who have had sexual intercourse before.
In people who have not had sexual intercourse, abdominal ultrasound is used. Many conditions such as ovarian and uterine cysts, structural problems related to internal genital organs can be detected. A number of blood tests are needed in addition to the physical exam and ultrasound examination. Generally, tests related to thyroid functions, ovarian function tests, levels of female and male sex hormones and prolactin levels are also applied together with the pregnancy test. Problems related to hormonal balance can be diagnosed with the help of these tests. Some hormonal imbalances such as high prolactin may be caused by benign tumors in the pituitary gland.
In the presence of such a situation, magnetic resonance (MR) examinations of the pituitary gland in the brain can be performed. If ovarian or uterine cysts are found on ultrasound, so-called tumor markers and malignancy of the tumor It is possible to apply for tests that give a preliminary information about whether it is beneficial or not. In case of doubtful results, biopsy and surgical operations should be resorted to. Likewise, ovarian cysts that carry risks such as bursting and sprain, although benign, should be surgically removed.
In the case of primary amenorrhea, follow-up may be recommended if no hormonal or anatomical problem or disease is detected. If there is a family history of late-onset menstrual bleeding, this can be considered normal. Some chromosomal disorders such as Down syndrome and Turner syndrome may not be able to reproduce. In such a case, amenorrhea is not a disease and does not require any intervention.
Surgical operations may be required if anatomical problems are detected. In secondary amenorrhea, if gynecological diseases or hormonal disorders are detected, treatment is applied for them. In the presence of reasons such as lifestyle problems, excessive exercise, and stress, patients are informed about the habits they need to change. If very thin people reach their ideal body mass by gaining weight in a healthy way under the control of a dietitian, their hormonal levels usually return to healthy ranges and the menstrual cycle begins.
In addition to these, in case of amenorrhea caused by any disease other than the reproductive organs, patients can be directed to different medical units to get information about the treatments for these diseases. In drug-induced cases, the treating physician should also be consulted about different drug alternatives.
If you are at reproductive age and do not have a special condition such as pregnancy or breastfeeding, if you have not had your period for more than three months, it would be beneficial to undergo an examination by a gynecologist. If necessary, according to your physician's recommendations, you can start your treatment process and ensure that your diseases are taken under control in the early period, and you can protect your health. You can use the contact form on our website to reach us.
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