Understanding Amenorrhea: Insights into Absence of Menstruation

Amenorrhea, defined as the absence of menstrual periods, affects a significant number of individuals, particularly during their adolescent years. In the UK, approximately 95% of girls experience menarche by the age of 15, while about 50% have their first period by 12.5 years. Understanding amenorrhea is crucial for identifying its underlying causes and implementing appropriate treatments.

There are two main types of amenorrhea: primary and secondary. Primary amenorrhea occurs when menstruation has not started by age 16, while secondary amenorrhea refers to the absence of periods in someone who has previously menstruated but has not had a period for over six months. To accurately diagnose and address amenorrhea, healthcare providers first assess whether estrogen is present or absent in the individual.

The investigation into amenorrhea often begins with a thorough medical history and physical examination, which requires sensitivity and patience. Factors such as excessive physical exercise, eating disorders like anorexia or bulimia, and psychological stressors, such as bullying or academic pressure, can contribute to secondary amenorrhea. Identifying these elements is essential for determining the correct intervention.

Differential diagnosis for amenorrhea includes various conditions affecting the hypothalamus and pituitary gland. Low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) may indicate hypothalamic or anterior pituitary deficiencies, while high LH and FSH levels suggest ovarian dysfunction. Conditions such as Turner syndrome, premature ovarian failure, or damage from medical treatments can also lead to amenorrhea.

Common symptoms accompanying amenorrhea can include significant weight changes, excessive physical activity, and psychological distress. Moreover, broader questions about overall health, including potential thyroid issues or unusual lactation (galactorrhea), should be addressed, as they may provide clues to the underlying cause of amenorrhea.

Addressing amenorrhea requires a collaborative approach, often involving healthcare professionals from various disciplines. By understanding the multifaceted nature of this condition, individuals experiencing amenorrhea can receive the appropriate support and care to help restore their menstrual health.