Amenorrhea

Etiologic Factors

1. Primary Amenorrhea (failure to menstruate by age 15):
   • Genetic or chromosomal abnormalities (e.g., Turner syndrome).
   • Structural issues (e.g., absent uterus or vaginal obstruction).
   • Endocrine disorders (e.g., hypothalamic dysfunction, pituitary gland disorders).
2. Secondary Amenorrhea (cessation of periods for more than 3 months after previously normal cycles):
   • Pregnancy (most common cause).
   • Stress, extreme weight loss, or excessive exercise (hypothalamic amenorrhea).
   • Polycystic Ovary Syndrome (PCOS).
   • Thyroid disorders (hyperthyroidism or hypothyroidism).
   • Hyperprolactinemia.
   • Menopause or premature ovarian insufficiency.
   • Medications (e.g., contraceptives, antipsychotics).

What to Look Out for When Seeking Professional Help

• Red Flags Requiring Medical Attention:
  • No period by age 15, or no breast development by age 13.
  • Sudden cessation of menstruation without a clear cause.
  • Associated symptoms like excessive hair growth (hirsutism), hot flashes, or galactorrhea (milk discharge).
  • Signs of systemic illness: fatigue, unexplained weight changes, or hair loss.
  • Pelvic pain or signs of an anatomical blockage.
  • History of eating disorders or extreme exercise.

Christopher Hobbs:

“Amenorrhea refers to conditions where menstruation has ceased. This often happens when a woman has moderate to severe anemia, for the body is attempting to preserve blood and vital energy. Menstruation and ovulation can also cease because of a hormonal imbalance. Finally, women who engage in very strenuous athletic programs, such as long-distance runners, can stop menstruating. This may be due to an increase in testosterone which the body produces in order to respond to the increased demand to build muscle tissue.”