What Is Amenorrhea?

Amenorrhea is a condition that refers to a woman who can not menstruate. This situation can occur when a woman is 16 years old but has not experienced menstruation or commonly called primary amenorrhea. In addition there is a secondary amenorrhea, that is when a woman of childbearing age who is not pregnant, did not get her period again after 6 months of last menstruation.

But this definition is still a debate in the medical community. Clinically, a 13-year-old woman who has not experienced signs of puberty such as breast growth and not yet menstruating, it is recommended to see a doctor. Similarly, women who have experienced menstruation, but not get a period within 90 days since the last menstruation.

Symptoms of Amenorrhea
In addition to not being able to menstruate, other accompanying symptoms depend on the cause of the amenorrhea itself. Symptoms are generally in the form:

• Headache.
• Breasts are not enlarged.
• Impaired vision.
• The growth of facial hair is excessive.
• Hair loss.
• Sounds heavy like a man.
• Acne .
• The discharge of breast milk while not breastfeeding, due to increased levels of prolactin.
• Pelvic pain.

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Causes of Amenorrhea
Before discussing the causes of amenorrhea, please note that there are natural causes of the absence of menstruation, namely:

• Pregnancy.
• Breastfeeding.
• Menopause .

Most of the causes of primary amenorrhea are when the ovaries do not produce or produce very little female sex hormones, estrogen and progesterone ( hypogonadism ). This occurs in conditions, among others:

Deficiency hormone gonadotropin releasing hormone (GnRH).

• Eating disorders.
• Failure to grow flowers.
• Hypopituitarism .
• Excess prolactin hormone.
• Tumors in the brain.
• Congenital adrenal hyperplasia .
• Cushing's syndrome.

In addition to hypogonadism, primary amenorrhea can be caused by:

• No uterine and vaginal formation, or cervix.
• Androgen insensitivity syndrome.

For secondary amenorrhea, here are some conditions that may be the cause.

• Use of contraception, especially injecting KB.
• Lifestyle, such as weight too low, weight loss, excessive exercise, and stress.
• Hormonal imbalances, such as in PCOS , hypothyroidism , tumors of the pituitary gland in the brain.
• Anorexia .
• Excess prolactin hormone.
• Abnormalities of reproductive organ structure, such as Asherman's syndrome.
• Primary ovarian insufficiency.
• Ovarian tumor.
• Cushing's syndrome .

Diagnosis of Amenorrhea
In addition to asking for symptoms and medical history of patients, doctors will perform physical examination, especially examination around the pelvis. A number of advanced tests that can be performed by a doctor in an amenorrhea patient are:

• Pregnancy test. In women who are sexually active, when they have secondary amenorrhea, the first thing a doctor will recommend is a pregnancy test.
• Blood test. Aim to see abnormalities of hormone levels that may be the cause of amenorrhea, such as prolactin, estrogen, thyroid, follicle-stimulating hormone (FSH), dehydroepiandrosterone sulfate (DHEA-S), and testosterone.
• Imaging . Ultrasound, CT scan, or MRI to see structural abnormalities in the reproductive organs, and if there is a suspected tumor in the pituitary gland ( pituitary ).

Treatment of Amenorrhea
Treatment depends on the cause of amenorrhea. Some of the methods of treatment advised by the physician according to the cause of amenorrhea, for example:

• Treatment in women with polycystic ovary syndrome (PCOS), treatment will focus on reducing androgen hormone levels.
• Use of contraceptive pills or hormone drugs that trigger the occurrence of the menstrual cycle.
• Estrogen replacement therapy (ERT) therapy helps stabilize hormones to trigger the menstrual cycle, under primary ovarian insufficiency conditions. ERT will replace the estrogen not produced by the ovaries to regulate the menstrual cycle normally. The doctor will also provide progestin or progesterone to reduce the risk of uterine cancer.
• Amenorrhea caused by lifestyle factors can be handled by keeping the ideal weight, controlling stress, and setting a proper and regular exercise schedule.

Complications Amenorrhea
Infertility is the most feared complication of amenorrhea. Another complication is due to low estrogen levels that cause reduced bone density or osteoporosis .