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Description:
What is Amenorrhea?
Amenorrhea is the absence or abnormal cessation of the menses (menstruation periods).
Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. The majority of the causes of primary and secondary amenorrhea are similar. Timing of the evaluation of primary amenorrhea recognizes the trend to earlier age at menarche and is therefore indicated when there has been a failure to menstruate by age 15 in the presence of normal secondary sexual development (two standard deviations above the mean of 13 years), or within five years after breast development if that occurs before age 10. Failure to initiate breast development by age 13 (two standard deviations above the mean of 10 years) also requires investigation. In women with regular menstrual cycles, a delay of menses for as little as one week may require the exclusion of pregnancy; secondary amenorrhea lasting three months and oligomenorrhea involving less than nine cycles a year require investigation.
The four most common causes are polycystic ovary syndrome, hypothalamic amenorrhea, ovarian failure, and hyperprolactinemia.
What Tests Are Used in the Diagnosis of Amenorrhea?
The initial useful laboratory tests are FSH, TSH, and prolactin.
Here are the characteristics of high/low levels of those three amenorrhea tests:
Elevated FSH Levels
High FSH levels are indicative of poor ovarian function. Ovarian failure can occur at any age, even in utero, when it is usually the result of gonadal agenesis or gonadal dysgenesis.
Amenorrhea associated with normal or low FSH values and chronic anovulation is frequently unexplained. The most common diagnostic categories are hypothalamic amenorrhea and polycystic ovary syndrome, and in each case similar but less common conditions must be excluded.
Elevated Prolactin Levels
Hyperprolactinemia (high prolactin blood levels) is associated with decreased estradiol concentrations and amenorrhea or oligomenorrhea (infrequent periods). Prolactin concentrations are higher in women with amenorrhea than in those with oligomenorrhea.
With persistent hyperprolactinemia, after ruling out primary hypothyroidism (high TSH), MRI of the pituitary is indicated. Mildly high prolactin levels could be a sign of another problem in the central nervous system, like congenital aqueductal stenosis, non-functioning adenomas, or any other problem that makes the pituitary stalk irritable.
When amenorrhea is associated with evidence of testosterone (androgen) excess, the most common disorder is polycystic ovary syndrome (PCOS). Less commonly, amenorrhea with hyperandrogenism arises from adrenal diseases, such as non-classical adrenal hyperplasia and Cushing syndrome or from androgen-producing tumors
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