Types Of Amenorrhea
- False Amenorrhea (Cryptomenorrhea)
- True Amenorrhea
- Physiological.
- Pathological–Primary Secondary
In this condition, there is periodic shedding of the endometrium and bleeding but the menstrual blood fails to come out from the genital tract due to obstruction in the passage.
This Obstruction Could be Due to
Vagina
- Imperforated hymen.
- Vaginal septum.
- Absence of vagina.
Could be congenital or acquired atresia.
Treatment
Simple dilatation of the cervix so as to drain the collected blood is enough. In cases of secondary atresia of the vagina, reconstructive surgery is to be done.
True Amenorrhoea
Physiological
Physiological causes of amenorrhea indicate the absence of menstruation due to natural conditions.
Before Puberty
The age of puberty is 12–14 years. The physiological amenorrhea is before the pubertal age. It is because the pituitary gonadotrophins are not adequate enough to stimulate the ovarian follicles for effective steroidogenesis and the estrogen levels are not sufficient enough to cause bleeding from the endometrium.
During Pregnancy
If a women of child bearing age complains of amenorrhea then it is likely that she is pregnant. During this period large amount of estrogens and progesterone are secreted from the trophoblasts (Link to glossary) which suppresses the pituitary gonadotrophins hence no maturation of the ovarian follicles.
During Lactation
Due to high levels of some hormones and low levels of others, there is no menstruation. If the patient does not breast feed her baby, the menstruation returns by 6th week following delivery in about 40 percent and by 12th week in 80 percent of cases. If the patient breast feeds her baby, the menstruation may be suspended in about 70 percent until the baby stops breast feeding.
Following Menopause
The menopausal age is 45–50 years. During this period no more follicles are available in the ovaries for the gonadotrophins to act. Due to which there is cessation of estrogen production from the ovaries with rise of pituitary gonadotrophins.
Pathological
Pathological causes indicate amenorrhea due to abnormal conditions.
Primary Amenorrhea
Young girls who have not menstruated by the age of 17 years could be having primary amenorrhea rather than delayed menarche.
Cause of Amenorrhea
Due to Some Medical Diseases
Genital tuberculosis or diabetes could be the reason in some cases. Such type of amenorrhea is usually associated with hypogonadism. Abnormal loss or gain in weight within short span of time shows some metabolic disorders.
Secondary Amenorrhea
When there is absence of periods for 6 months following normal menstruation, it is called secondary amenorrhea. It may be physiological, concealed (cryptomenorrhea) or true secondary amenorrhea. No matter what the type of amenorrhea, it requires proper diagnosis and treatment in due course of time.