The Concise Encyclopedia of Women's Sexual and Reproductive Health

Healthy Home Library

Deborah Mitchell

St. Martin's Paperbacks

The absence of menstruation during puberty or later in a woman's life is called amenorrhea. This condition occurs in two forms, primary and secondary amenorrhea. The absence of menstruation and secondary sexual characteristics (pubic hair, breast development) in females by age fourteen or the absence of menstruation with normal development of secondary sexual characteristics in girls by age sixteen is primary amenorrhea. This affects less than 3 percent of adolescent girls. Females who were menstruating but then stop for three consecutive months or longer have secondary amenorrhea. Some experts qualify this definition by excluding the cessation of menstruation associated with pregnancy, lactation, use of birth control pills, or menopause; however, the first definition is the one more commonly used. Secondary amenorrhea is much more common than the primary form and typically is not serious.

Amenorrhea is a symptom of an underlying condition (see "Causes and Risk Factors") rather than a disease, and so additional symptoms may occur depending on what that condition is. Symptoms often associated with amenorrhea include headache, milky discharge from the nipples, hot fl ashes, sleep problems, severe anxiety, and excessive hair growth on the face and/or torso.

CAUSES AND RISK FACTORS

For some adolescent girls, the cause of primary amenorrhea is unknown. The most common reasons are heredity, poor nutrition, or an endocrine problem (e.g., hypothyroidism or a pituitary tumor). Other causes include a hormonal imbalance, eating disorders (e.g., anorexia nervosa, bulimia), extreme obesity, and excessive exercise. Young girls who take part in intensive physical training prior to puberty, which is common among gymnasts and ballet dancers, can delay the start of menstruation by up to five months for every year of training they have done.

Secondary amenorrhea may be caused by many of the same factors associated with the primary form, although the most common cause of secondary amenorrhea is pregnancy. Other causes include lactation, the use of certain medications (e.g., antidepressants, antipsychotics, chemotherapy drugs), chronic illness, uterine fibroids, premature menopause, use of birth control pills, menopause, and polycystic ovary syndrome.

DIAGNOSIS

To determine the cause of amenorrhea, your health care provider may run blood tests to determine the levels of hormones secreted by the ovaries (estrogen) and the pituitary gland (prolactin, luteinizing hormone [LH], thyroid- stimulating hormone [TSH], and follicle- stimulating hormone [FSH]), all of which have an impact on menstruation. He or she may also order an ultrasound of the pelvic area to identify any abnormalities, including polycystic ovaries, or an MRI or CT scan of the head to see if the pituitary or hypothalamus is causing the amenorrhea. Other tests that are sometimes ordered include thyroid function, hysteroscopy (to visually inspect the inside of the uterus), and saline infusion sonography or hysterosalpingogram, both of which allow the clinician to examine the uterus.

PREVENTION AND TREATMENT

Ways to prevent and treat amenorrhea often coincide. Eating a balanced diet, for example, can both prevent amenorrhea and help restart the menstrual cycle in women who have nutritional deficiencies or who have been dieting excessively. Excessive vigorous exercise (e.g., regular long- distance running or gymnastics) may cause your periods to stop, while a moderate exercise program may help restore them. Amenorrhea caused by excessive stress may be resolved if you adopt ways to effectively manage stress.

If excess secretion of prolactin (hyperprolactinemia) is causing amenorrhea, then medications such as bromocriptine or pergolide may be used to restore function to the ovaries. If ovary function cannot be restored, hormone replacement therapy may be needed to resolve estrogen deficiency and help maintain bone density. Women who need their estrogen deficiency resolved but who do not want to become pregnant may be prescribed oral contraceptives.

A natural supplement approach to amenorrhea can include gamma- linolenic acid (GLA), an essential fatty acid that comes mainly from plant- based oils. Linoleic acid, which is found in cooking oils, is converted into GLA in the body. GLA supplements are available as borage oil, black currant seed oil, and evening primrose oil. These essential fatty acids help reduce inflammation and support hormone production. Some experts recommend taking 1,000 to 1,500 mg one or two times daily.

OTHER HELPFUL INFORMATION

Although premature cessation of your menstrual cycle has an upside (who misses tampons, pads, and cramps?), the downside is the potential loss in bone density and the accompanying increased risk of osteoporosis if you experience amenorrhea for more than three to four months. To help prevent damage to your bone health, talk to your health care provider about correcting the lack of periods and make sure you get adequate calcium, vitamin D, and magnesium through diet and supplements.

READ MORE ABOUT IT

American Society for Reproductive Medicine, 1209 Montgomery Highway, Birmingham, AL 35216- 2809; 205- 978-5000; www .asrm .org .

ICON Health Publications. Amenorrhea: A Medical Dictionary, Bibliography and Annotated Research Guide to Internet References. ICON Health Publications, 2004.

Lachowsky M, Winaver D. Psychogenic amenorrhea. Gynecol Obstet Fertil 2007 Jan; 35(1): 45—48.

Excerpted from A CONCISE ENCYCLOPEDIA OF WOMEN'S SEXUAL AND REPRODUCTIVE HEALTH by Deborah Mitchell

Copyright © 2009 by Lynn Sonberg Book Associates

Published in March 2009 by St. Martin's Press

All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the Publisher.

AMENORRHEA

The absence of menstruation during puberty or later in a woman's life is called amenorrhea. This condition occurs in two forms, primary and secondary amenorrhea. The absence of menstruation and secondary sexual characteristics (pubic hair, breast development) in females by age fourteen or the absence of menstruation with normal development of secondary sexual characteristics in girls by age sixteen is primary amenorrhea. This affects less than 3 percent of adolescent girls. Females who were menstruating but then stop for three consecutive months or longer have secondary amenorrhea. Some experts qualify this definition by excluding the cessation of menstruation associated with pregnancy, lactation, use of birth control pills, or menopause; however, the first definition is the one more commonly used. Secondary amenorrhea is much more common than the primary form and typically is not serious.

Amenorrhea is a symptom of an underlying condition (see "Causes and Risk Factors") rather than a disease, and so additional symptoms may occur depending on what that condition is. Symptoms often associated with amenorrhea include headache, milky discharge from the nipples, hot fl ashes, sleep problems, severe anxiety, and excessive hair growth on the face and/or torso.

CAUSES AND RISK FACTORS

For some adolescent girls, the cause of primary amenorrhea is unknown. The most common reasons are heredity, poor nutrition, or an endocrine problem (e.g., hypothyroidism or a pituitary tumor). Other causes include a hormonal imbalance, eating disorders (e.g., anorexia nervosa, bulimia), extreme obesity, and excessive exercise. Young girls who take part in intensive physical training prior to puberty, which is common among gymnasts and ballet dancers, can delay the start of menstruation by up to five months for every year of training they have done.

Secondary amenorrhea may be caused by many of the same factors associated with the primary form, although the most common cause of secondary amenorrhea is pregnancy. Other causes include lactation, the use of certain medications (e.g., antidepressants, antipsychotics, chemotherapy drugs), chronic illness, uterine fibroids, premature menopause, use of birth control pills, menopause, and polycystic ovary syndrome.

DIAGNOSIS

To determine the cause of amenorrhea, your health care provider may run blood tests to determine the levels of hormones secreted by the ovaries (estrogen) and the pituitary gland (prolactin, luteinizing hormone [LH], thyroid- stimulating hormone [TSH], and follicle- stimulating hormone [FSH]), all of which have an impact on menstruation. He or she may also order an ultrasound of the pelvic area to identify any abnormalities, including polycystic ovaries, or an MRI or CT scan of the head to see if the pituitary or hypothalamus is causing the amenorrhea. Other tests that are sometimes ordered include thyroid function, hysteroscopy (to visually inspect the inside of the uterus), and saline infusion sonography or hysterosalpingogram, both of which allow the clinician to examine the uterus.

PREVENTION AND TREATMENT

Ways to prevent and treat amenorrhea often coincide. Eating a balanced diet, for example, can both prevent amenorrhea and help restart the menstrual cycle in women who have nutritional deficiencies or who have been dieting excessively. Excessive vigorous exercise (e.g., regular long- distance running or gymnastics) may cause your periods to stop, while a moderate exercise program may help restore them. Amenorrhea caused by excessive stress may be resolved if you adopt ways to effectively manage stress.

If excess secretion of prolactin (hyperprolactinemia) is causing amenorrhea, then medications such as bromocriptine or pergolide may be used to restore function to the ovaries. If ovary function cannot be restored, hormone replacement therapy may be needed to resolve estrogen deficiency and help maintain bone density. Women who need their estrogen deficiency resolved but who do not want to become pregnant may be prescribed oral contraceptives.

A natural supplement approach to amenorrhea can include gamma- linolenic acid (GLA), an essential fatty acid that comes mainly from plant- based oils. Linoleic acid, which is found in cooking oils, is converted into GLA in the body. GLA supplements are available as borage oil, black currant seed oil, and evening primrose oil. These essential fatty acids help reduce inflammation and support hormone production. Some experts recommend taking 1,000 to 1,500 mg one or two times daily.

OTHER HELPFUL INFORMATION

Although premature cessation of your menstrual cycle has an upside (who misses tampons, pads, and cramps?), the downside is the potential loss in bone density and the accompanying increased risk of osteoporosis if you experience amenorrhea for more than three to four months. To help prevent damage to your bone health, talk to your health care provider about correcting the lack of periods and make sure you get adequate calcium, vitamin D, and magnesium through diet and supplements.

READ MORE ABOUT IT

American Society for Reproductive Medicine, 1209 Montgomery Highway, Birmingham, AL 35216- 2809; 205- 978-5000; www .asrm .org .

ICON Health Publications. Amenorrhea: A Medical Dictionary, Bibliography and Annotated Research Guide to Internet References. ICON Health Publications, 2004.

Lachowsky M, Winaver D. Psychogenic amenorrhea. Gynecol Obstet Fertil 2007 Jan; 35(1): 45—48.

Excerpted from A CONCISE ENCYCLOPEDIA OF WOMEN'S SEXUAL AND REPRODUCTIVE HEALTH by Deborah Mitchell

Copyright © 2009 by Lynn Sonberg Book Associates

Published in March 2009 by St. Martin's Press

All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the Publisher.

Copyright © 2009 by Franz Wisner

Published in March 2009 by St. Martin's Press

All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the Publisher.