What is Amenorrhea - Primary Amenorrhea, Secondary Amenorrhea and their Causes?

Amenorrhea means the absence of Menstration [Menstruation], which can happen during puberty or later in life. There are two types of amenorrhoea, which include primary and secondary amenorrhoea. Secondary amenorrhoea is when Menstration [Menstruation] has stopped for six consecutive months in a woman who has previously had regular periods. The underlying cause of Amenorrhea is usually hormonal. The causes of amenorrhea include certain genetic defects, body structure abnormalities, or endocrine disorders.

Specific Amenorrhea Causes include the following.

• Pregnancy or breast-feeding.
• Being very underweight caused by serious illness.
• Extreme overweight (obesity).
• Developmental problems, such as the absence of the uterus or vagina.
• Hormone imbalance produced by the endocrine system.
• Excessive amounts of the male hormone testosterone.
• Improper functioning of the ovaries.
• Intrauterine infection or endometritis.
• Premature Menopause, usually between the ages of 40 and 50.
• Discontinuation of oral contraceptives.
• Diseases such as diabetes mellitus or tuberculosis.
• Eating disorders.
• Stress or psychological disorders.
• Excessive exercise.
• Drug abuse

The causes of primary amenorrhea are quite different from secondary amenorrhea. Mentioned below are some causes of both primary and secondary amenorrhea.

Causes of Primary Amenorrhea:

Primary amenorrhoea is used to describe the absence of a period in young women who haven't started menstruating by age 16. The most common causes of primary amenorrhea include:

• Chromosomal abnormalities: Certain chromosomal abnormalities can cause a premature depletion of the eggs and follicles involved in ovulation and Menstration [Menstruation].
• Lack of reproductive organs: Sometimes problems arise during fetal development that lead to a baby girl being born without some major part of her reproductive system, such as her uterus, cervix or vagina. Because her reproductive system didn't develop normally, she won't have menstrual cycles.
• Problems with the hypothalamus: Hypothalamus is an area at the base of your brain that acts as a control center for your body and regulates your menstrual cycle. Eating disorders such as anorexia, excessive exercise, and physical or psychological stress can all contribute to a disruption in the normal function of the hypothalamus. Less commonly, a tumor may prevent your hypothalamus from functioning normally.
• Pituitary disease: Pituitary disease is any condition that affects the pituitary. The pituitary is another gland in the brain that's involved in regulating the menstrual cycle. A tumor or other invasive growth may disrupt the pituitary gland's ability to perform this function.
• Structural abnormality of the vagina: An obstruction of the vagina may prevent menstrual periods from occurring. A membrane or wall may be present in the vagina that blocks the outflow of blood from the uterus and cervix.

Causes of Secondary Amenorrhea:

Secondary amenorrhea is much more common than primary amenorrhea. Many possible causes of secondary amenorrhea exist:

• Pregnancy: Pregnancy is the main cause of secondary amenorrhea in women of reproductive age. When a fertilized egg is implanted in the lining of the uterus, the lining remains to nourish the fetus and isn't shed by Menstration [Menstruation].
• Contraceptives. Some women who take contraceptives or birth control pills may not have periods. When oral contraceptives are stopped, it may take three to six months to resume regular ovulation and Menstration [Menstruation]. Contraceptives that are injected or implanted may also cause amenorrhea.
• Breast-feeding: Mothers who breast-feed can often experience amenorrhea. Although ovulation may occur, Menstration [Menstruation] may not. Pregnancy can result despite the lack of Menstration [Menstruation].
• Stress: Stress can temporarily alter the functioning of your hypothalamus, an area of your brain that controls the hormones that regulate your menstrual cycle. As a result ovulation and Menstration [Menstruation] may stop. Regular menstrual periods usually resume after your stress decreases.
• Medication. Certain medications can cause menstrual periods to stop. For example, Medications such as antipsychotic, antidepressants, chemotherapy drugs and oral corticosteroids may cause amenorrhea.
• Illness. Chronic illness may postpone menstrual periods but won't stop them. As you recover, Menstration [Menstruation] typically resumes.
• Hormonal imbalance. A common cause of amenorrhea or irregular periods is polycystic ovary syndrome (PCOS). This causes relatively high and sustained levels of estrogen and androgen, a male hormone, rather than the fluctuating condition seen in the normal menstrual cycle. This results in a decrease in the pituitary hormones that lead to ovulation and Menstration [Menstruation]. PCOS is associated with amenorrhea, obesity, often heavy uterine bleeding; acne and sometimes excess facial hair.
• Low body weight. Excessively low body weight may be due to some illness interrupts many hormonal functions in your body, potentially halting ovulation. Women who have an eating disorder, such as anorexia or bulimia, often stop having periods because of these abnormal hormonal changes.
• Excessive exercise. Sports that require rigorous training, such as ballet, long-distance running or gymnastics, may be responsible for the interruption of menstrual cycle in many women. Several factors including low body fat, stress and high-energy expenditure contribute to the loss of periods in athletes.
• Thyroid disorder. In many cases, an underactive thyroid gland or an overactive thyroid gland commonly causes menstrual irregularities, including amenorrhea. Thyroid disorders can also cause an increase or decrease in the production of prolactin , a reproductive hormone generated by your pituitary gland. An altered prolactin level can affect your hypothalamus and disrupt your menstrual cycle.
• Premature menopause. Menopause generally occurs at an average age of 51. If you experience menopause before age 40, it's considered premature. The lack of ovarian function associated with menopause decreases the amount of circulating estrogen in your body, which in turn thins your uterine lining and brings an end to your menstrual periods. Premature menopause may result from genetic factors or autoimmune disease, but often no cause can be found.
• Pituitary tumor. A noncancerous tumor in your pituitary gland can cause an overproduction of prolactin. Excess prolactin can interfere with the regulation of Menstration [Menstruation]. This type of tumor can be treated with medication, but it sometimes requires surgery.
• Uterine scarring. Asherman's syndrome, a condition in which scar tissue builds up in the lining of the uterus, can sometimes occur after uterine procedures, such as a dilation and curettage, Caesarean section or treatment for uterine fibroids. Uterine scarring prevents the normal buildup and shedding of the uterine lining, which can result in very light menstrual bleeding or no periods at all.