What is it?
Amenorrhoea is the term for the lack of menstrual function in women. This means that the woman experiences no menstrual bleeds and will be infertile. Amenorrhoea may be primary amenorrhoea or secondary amenorrhoea.
Primary amenorrhoea is when the woman has never had a menstrual cycle or menstrual bleed. It occurs in about 3 in 1000 women.
Secondary amenorrhoea is when a woman has had menstrual periods in the past but these have now stopped. This occurs in about 3 in 100 women. The previous menstrual activity may have been quite brief but has shown that the woman’s hormones were once functioning in a relatively normal way.
Menstrual function depends on a number of factors that the clinician has to consider. These include:
- Genetic factors
- Weight
- Diet
- Health, including exercise and stress
- Drugs
- Activity of hormones from the brain and ovary
- Structure of the reproductive tracts
- Endocrine disease e.g. thyroid hormone disorder
- A long-term illness
Sometimes the cause of amenorrhoea may be straightforward such the effect of certain drugs or due to intensive exercise. Even another chronic illness can cause amenorrhoea. In other cases the cause is not immediately obvious and may require extensive investigation.
Tests
The investigation of amenorrhoea in women can be quite complex and tests depend on what the doctor finds out about you at your first visit.
Initially the doctor will ask you about your menstrual function since puberty, your life style and your sexual activity. They will want to know about any other condition you may be suffering from and what drugs you are on.
They will probably carry out a physical examination and want to take a blood sample. The blood sample is usually for the measurement of hormones such as chorionic gonadotrophin (hCG), luteinising hormone (LH), follicle stimulating hormone (FSH) and prolactin. Other hormones which may be measured are thyroid hormones, testosterone and oestradiol. But blood analysis depends on what the doctor finds out from you and what he suspects may be the cause of your amenorrhoea.
Other, later tests may include ultrasound scanning of the ovaries and possibly a scan of the head, genetic investigation and further blood tests.
Treatment
Treatment depends on the cause of the amenorrhoea.