Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Amenorrhea is the medical term for the absence of menstrual periods, either on a
permanent or temporary basis. Amenorrhea can be classified as primary or
secondary. In primary amenorrhea, menstrual periods have never begun (by age
16), whereas secondary amenorrhea is defined as the absence of menstrual periods
for three consecutive cycles or a time period of more than six months in a woman
who was previously menstruating.
The menstrual cycle can be influenced by many internal factors such as
transient changes in hormonal levels, stress, and illness, as well as external or
environmental factors. Missing one menstrual period is rarely a sign of a
serious problem or an underlying medical condition, but amenorrhea of longer
duration may signal the presence of a disease or chronic condition.
What causes amenorrhea?
The normal menstrual cycle occurs because of changing levels of hormones made
and secreted by the ovaries. The ovaries respond to hormonal signals from the pituitary gland located at the
base of the brain, which is, in turn, controlled by hormones produced in the hypothalamus of the brain.
Disorders that affect any component of this regulatory cycle can lead to
amenorrhea. However, a common cause of amenorrhea in young females sometimes
overlooked or misunderstood by the individual and others, is an undiagnosed pregnancy. Amenorrhea in
pregnancy is a normal physiological function. Occasionally, the same underlying
problem can cause or contribute to either primary or secondary amenorrhea. For
example, hypothalamic problems, anorexia or extreme exercise can
play a major role in causing amenorrhea depending on the age of the person and
if she has experienced menarche.
Primary amenorrhea
Primary amenorrhea is typically the result of a genetic or anatomic condition
in young females that never develop menstrual periods (by age 16) and is not
pregnant. Many genetic conditions that are characterized by amenorrhea are
conditions in which some or all of the normal internal female organs either fail
to form normally during fetal development or fail to function properly. Diseases
of the pituitary gland and hypothalamus (a region of the brain important for the
control of hormone production) can also cause primary amenorrhea since these
areas play a critical role in the regulation of ovarian hormones.
Gonadal dysgenesis is the name of a condition in which the ovaries are
prematurely depleted of follicles and oocytes (egg cells) leading to premature
failure of the ovaries. It is one of the most common cases of primary amenorrhea
in young women.
Another genetic cause is Turner syndrome, in which women are
lacking all or part of one of the two X chromosomes normally present in the
female. In Turner syndrome, the ovaries are replaced by scar tissue and estrogen production is minimal,
resulting in amenorrhea. Estrogen-induced maturation of the external female genitalia and
sex characteristics also fails to occur in Turner syndrome.
Other conditions that may be causes of primary amenorrhea include androgen
insensitivity (in which individuals have XY (male) chromosomes but do not
develop the external characteristics of males due to a lack of response to
testosterone and its effects),
congenital adrenal hyperplasia, and
polycystic ovary syndrome (PCOS).
Secondary amenorrhea
Pregnancy is an obvious cause of amenorrhea and is the most common reason for
secondary amenorrhea. Further causes are varied and may include conditions that
affect the ovaries, uterus, hypothalamus, or pituitary gland.
Hypothalamic amenorrhea is defined as amenorrhea that is due to a disruption
in the regulator hormones produced by the hypothalamus in the brain. These
hormones influence the pituitary gland, which in turn sends signals to the
ovaries to produce the characteristic cyclic hormones. A number of conditions
can affect the hypothalamus and lead to hypothalamic amenorrhea, such as:
Other types of medical conditions can cause secondary amenorrhea:
tumors or other diseases of the pituitary gland that lead to elevated
levels of the hormone
prolactin (which is involved in milk production) also cause amenorrhea due
to the elevated prolactin levels;
elevated levels of androgens (male hormones), either from outside sources
or from disorders that cause the body to produce too high levels of male
hormones;
Asherman's syndrome is an example of uterine disease that causes
amenorrhea. It results from scarring of the
uterine lining following
instrumentation (such as dilation and curettage) of the
uterine cavity to manage postpartum bleeding or infection.
Post-pill amenorrhea
Women who have stopped taking oral contraceptive pills should
experience the return of menstruation within three months after discontinuing
pill use. Previously, it was believed that birth control pills increased a
woman's risk of amenorrhea following use of the pill, but this has been proven
not to be the case. Women who do not resume menstruation after three months have
passed since oral contraceptive pills were stopped should be evaluated for
causes of secondary amenorrhea.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Anorexia is an eating disorder characterized by markedly reduced appetite or total aversion to food. Anorexia is a serious psychological disorder and is a condition that goes well beyond out-of-control dieting. With anorexia, the drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. There are psychological and behavioral symptoms as well as physical symptoms of anorexia including: depression, social withdrawal, fatigue, food obsession, heart and gastrointestinal complications, kidney function, flaky skin, brittle nails, and tooth loss (this list is not exhaustive).
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Symptoms include abdominal pain, amenorrhea, and vaginal bleeding. Treatment options include observation, medication, or surgery.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Pregnancy symptoms vary from woman to woman. There are some symptoms that are more frequent in some women. These symptoms include a missed period, nausea, vomiting, bloating, weight gain, headaches, food cravings, and mood changes.
Infertility is the diminished ability to conceive a child. The primary cause of infertility in men is a sperm disorder. In women, the primary cause of infertility is an ovulation disorder. Most forms of infertility can be treated. Conventional infertility therapies include drugs or surgery.
Turner syndrome is an inherited chromosomal condition affecting women. Women with Turner syndrome do not have ovarian function, and features of the syndrome include webbed neck, lymphedema of the hands and feet, heart defects, kidney problems, and skeletal abnormalities. The X chromosome is related to Turner syndrome. Treatment focuses on the symptoms of the syndrome.
Premature menopause is when a woman goes through menopause before the age of 40 because of genetics, illness, or a medical procedure. Symptoms of premature menopause include irregular or missed periods, mood swings, hot flashes, periods that are heavier or lighter than usual, vaginal dryness, bladder irritability, incontinence, dry skin, eyes or mouth, sleeplessness, and decreased sex drive. Though premature menopause cannot be reversed, the symptoms can be managed with methods similar to those used for natural menopause.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Trying to get conceive, or become pregnant can be challenging, frustrating, and an emotional rollercoaster for some couples. There are things you can do to chart progress, which may ultimately lead to a successful healthy pregnancy, or, when necessary, lead to discussions with a fertility specialist. Being aware of your menstrual cycle, charting your fertility pattern, knowing the reasons for infertility, and treating infertility are key points to discuss with your partner and physician.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
Premature ovarian failure (POS) is the cessation of normal functioning of the ovaries in women under the age of 40. Premature ovarian failure may be caused by follicle depletion or dysfunction. The most common symptom of premature ovarian failure are irregular periods. There is no "treatment" that will restore the ovarian function, but there are treatments that my relieve symptoms.
Normal vaginal bleeding is the periodic blood that flows
as a discharge from
the woman's uterus. Normal vaginal bleeding is also called menorrhea. The
process by which menorrhea occurs is called
menstruation.
Normal vaginal bleeding occurs as a result of cyclic
hormonal changes. The ovaries are the main source of female hormones, which
control the development of
female body characteristics such as the
breasts, body shape, and body hair. The
hormones also regulate the menstrual cycle. The ovary, or female gonad, is one of
a pair of reproductive glands in women. They are located in the pelvis, one on
each side of the uterus. Each ovary is about the size and shape of an almond.
The ovaries produce eggs (ova) and female hormones. During each monthly
menstrual cycle, an egg is released from one ovary. The egg travels from the
ovary through a Fallopian tube to the
uterus.