Amenorrhea, oligomenorrhea and dysmenorrhoea are included in menstrual problems. Primary or secondary amenorrhea is the absence of or cessation of menstrual cycles. The term for irregular periods is oligomenorrhoea. More than 35 days (and fewer than 6 months) pass between bleeding episodes. The reasons are the same, as are the assessment and therapy.
- Primary amenorrhoea is the inability to start menstruating by 16 years of age with typical secondary sexual traits, or by 14 years of age in the lack of other puberty-related symptoms. The development of secondary sexual features is evaluated using the Tanner stages of pubertal development.
- Secondary amenorrhoea is the condition in which a woman who had regular menstruation for at least six months, or twelve months if she had oligomenorrhoea prior, does not have her period.
- About 3–4% of women have amenorrhoea (not caused by pregnancy, nursing, or menopause).
- Amenorrhoea is caused by an axis disruption of the hypothalamus-pituitary-ovarian (H-P-O).
- Causes of oligomenorrhoea and primary and secondary amenorrhoea overlap.
- 60% of secondary amenorrhoea is ovarian, 35% hypothalamus, and 5% uterine in origin. Among the most frequent are hyperprolactinaemia, early ovarian failure, and PCOS.
Complications
Osteoporosis and maybe cardiovascular disease are more likely to strike women with amenorrhoea linked to oestrogen shortage.
One effect of anovulation is infertility.
Management
History
A complete clinical history should include a menstrual history and a drug history, including recreational substances like heroin, that are known to induce hyperprolactinaemia. One should ask about stress, strenuous exercise, and weight reduction. Uterine curettage history should be noted, for example, following an abortion or miscarriage. Galactorrhoea can be a sign of hyperprolactinaemia, which could be caused by a prolactinoma.
Examination of amenorrhea and oligomenorrhoea
BMI; hirsuitism; male pattern baldness (which may indicate an androgen secreting tumour); galactorrhoea; thyroid disease symptoms of Amenorrhea and oligomenorrhoea.
Investigations: Tests for pregnancy, FSH/LH levels, prolactin, thyroid function (TSH), testosterone, and free androgen index. The transvaginal ultrasound scan can establish normal uterine anatomy and detect polycystic ovaries.
The results may suggest that more testing be ordered (Table 29.3). Investigation of primary amenorrhoea may need karyotyping, and an abdominal ultrasound scan is performed instead of a transvaginal one.
Treatment is determined by the diagnosis and the problems of the patients (infertility, for example). Osteoporosis prevention requires replacement of oestrogens.
This can be achieved with the COC provided fertility is not necessary.
Sometimes women with oligomenorrhoea and amenorrhea ovulate spontaneously, so if pregnancy is to be avoided, contraception is advised. Teenage women with primary amenorrhea may require artificial induction of puberty under the supervision of a paediatric endocrinologist.
Polycystic ovarian syndrome (PCOS)
Secondary amenorrhoea most often results from PCOS, a complicated endocrine condition. Unknown in nature, the reason is probably complex.
Common characteristics include hirsuitism, acne, and obesity; in many women, insulin resistance and the ensuing hyperinsulinaemia are important pathogenic elements.
Increased risk of cardiovascular disease, endometrial hyperplasia and endometrial cancer, infertility due to anovulation, and link with sleep apnoea are complications.
Control: The symptoms will determine this. The symptoms can be much improved by lifestyle modifications meant to normalize body weight. A five to ten percent weight decrease can bring back normal menstruation. Preventing hyperplasia and preserving the endometrium need regulation of the menstrual cycle. In ladies who do not want to conceive, this can be accomplished by employing a COC. Another excellent choice for endometrial protection is the LNG-IUS. One can treat acne and hirsuitism medically. Usually, anovulatory infertility is treated with clomifene citrate ovulation induction under the guidance of a fertility doctor. Insulin-sensitising medications like metformin may have a place, however they are only to be used by specialists and are not licenced in the UK.
Dysmenorrhoea
Palpitation pain that starts at or just before menstruation. Between 50 and 90 percent of menstrual women are affected by this very frequent condition.
Traditionally divided as primary (no discernible underlying pathology) or secondary (linked to underlying pelvic pathology, such as endometriosis)
The release of prostaglandins is assumed to be the aetiology of primary dysmenorrhoea, which increases myometrial contractility and produces cramping pain. Additionally, believed to be a result of prostaglandin production, some women experience stomach problems.
Management
History: Find out when symptoms first appeared in connection to menarche and whether any related symptoms—like dyspareunia, PCB, or IMB—may point to underlying disease. Ascertain the effect on the woman’s life.
Examine: All women should get an abdominal exam. Unless the woman is an adolescent with a normal past of mild symptoms and has never been sexually active, a pelvic examination is recommended.
Investigations: If suspicious, STI screening. A pelvic mass may be suspected, in which case a pelvic ultrasound could be useful. Endometriomas, fibroids, hydrosalpinges, or other anomalies may be shown by it. It could be necessary to get a diagnostic laparoscopy
Treatment: No more investigations are necessary if the examination is normal. If relevant, treat underlying pathology.
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