Amenorrhea, why women can not menstruating?

DEFINITIONS
Amenorrhea is the absence of menstruation.  If menstruation has never occurred, it is called primary amenorrhea if menstruation had occurred but then stopped for 6 months or more so-called secondary amenorrhea.

Amenorrhea is normal only before puberty, during pregnancy, during breastfeeding and after menopause.

CAUSE
Amenorrhea can result from abnormalities in the brain, pituitary gland, thyroid gland, adrenal glands, ovaries (ovarian) as well as other parts of the reproductive system.
Under normal circumstances, the hypothalamus (part of the brain located above the pituitary gland) sends a signal to the pituitary gland to release hormones that stimulate the release of eggs by the ovaries. In particular Disease, abnormal pituitary hormone formation can cause inhibition of the release of an egg cell and disruption of a series of hormonal processes involved in the occurrence of menstruation.

Causes of primary amenorrhea:

1. Delayed menarche (first menstruation)
2. Congenital abnormalities in the genital system (for example, has no uterus or vagina, the septum in the vagina, the cervix is narrow, the hole in the membrane covering the vagina is too narrow / imperforate hymen)
3. Drastic weight loss (due to poverty, excessive dieting, anorexia nervosa, bulimia, etc.)
4. Congenital abnormalities in the sex chromosome abnormalities (eg Turner’s syndrome or Swyer syndrome) in which the cells contain only one X chromosome)
5. Extreme Obesity
6. Hypoglycemia
7. Gonadal dysgenesis
8. Hypogonadotropic hypogonadism
9. Testicular feminization syndrome
10. True hermaphrodite
11. Chronic Disease
12. Undernourishment
13. Cushing’s Disease
14. Cystic Fibrosis
15. Congenital heart disease (sianotik)
16. Kraniofaringioma, ovarian tumors, adrenal tumors
17. Hypothyroidism syndrome Adrenogenital
18. Prader-Willi Syndrome
19. Ovarian disease polikista
20. Congenital adrenal hyperplasia

Causes of secondary amenorrhea:

1. Pregnancy Anxiety will pregnancy
2. Drastic weight loss
3. Excessive Exercise
4. Body fat of less than 15-17% extreme
5. Consuming an additional hormone
6. Obesity
7. Emotional stress
8. Menopause
9. Endocrine disorders (eg Cushing’s syndrome, which produces massive amounts of the hormone cortisol by the adrenal gland)
10. Drugs (eg busulfan, klorambusil, cyclophosphamide, oral contraceptives, fenotiazid)
11. Dilatation and curettage procedure
12. Abnormalities of the uterus, such as hydatidiform mole (tumor placenta) and Asherman’s syndrome (scarring of the lining of the uterus due to infection or surgery).

SYMPTOMS

Symptoms vary, depending on the cause.

If the cause is the unfortunate of puberty, it will not be found the signs of puberty such as breast enlargement, hair growth of pubic and underarm hair nd changes in body shape.

If the cause is pregnancy, morning sickness will be found and an enlarged abdomen. If the cause is a thyroid hormone levels are high then the symptoms are rapid heartbeat, anxiety, skin warm and moist.

Cushing’s syndrome causes a round grappling (moon face), distended abdomen and arms and legs are thin.

Other symptoms that might be found in amenorrhea:

• Headache
• Galactorrhea (formation of breast milk in women who are not pregnant and not breastfeeding)
• Impaired vision (on pituitary tumor)
• The decline or significant weight gain
• Vaginal dryness
• Hirsutism (excessive hair growth, which follows the pattern of male), voice changes and changes in breast size

DIAGNOSIS

Diagnosis based on symptoms, physical examination and patient age

Inspection is usually done is:

• Endometrial Biopsy
• Progestin withdrawal
• Levels of the hormone prolactin levels (eg testosterone)
• Thyroid function tests
• Pregnancy test
• Levels of FSH (follicle stimulating hormone), LH (luteinizing hormone), TSH (thyroid stimulating hormone)
• Karyotype to refer chromosomal abnormalities
• CT scan of the head (if there is suspected pituitary tumor).

TREATMENT

Treatment depends on the cause. If the cause is a drastic weight loss or obesity, patients are advised to undergo proper diet. If the cause is excessive exercise, patients are encouraged to reduce them. If a girl has never experienced menstruation and all results are normal, then the examination each 3-6 months to monitor the development of puberty. To stimulate menstruation can be given progesterone.

To stimulate the changes of puberty in girls who have enlarged breasts or pubic and armpit hair has not grown, can be given estrogen. If the cause is a tumor, then performed surgery to remove the tumor tesebut. Pituitary tumor located in the brain are usually treated with bromocriptine to prevent excessive release of prolactin by the tumor. If necessary can be removal of the tumor. Radiation therapy is usually only done if the administration of drugs or surgery was not successful.

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