Amenorrhoea Primary

WHAT IS PRIMARY AMENORRHOEA?

In India most girls begin menstruating between 9-14 years of age. The onset of menstrual cycles in a girl is called as menarche. When, in a girl, menarche is delayed beyond 18 years of age, it is known as primary amenorrhoea.

CAUSES

Variety of causes but after detailed investigations mostly unknown.

Possible causes include:

  • Inborn abnormalities - such as the absence or abnormal formation of female organs (vagina, uterus, ovaries).
  • Intact hymen with no opening to allow passage of menstrual blood.
  • Disorders (tumors, infections, or lack of maturation) of the endocrine (hormonal) system.
  • Chromosome disorders.
  • Emotional distress.
  • Eating disorders, including obesity, bulimia, anorexia nervosa, excessive dieting or starvation.
  • Long standing systemic diseases like tuberculosis, severe anemia.
  • Participation in highly competitive, strenuous athletic activities.
  • Pregnancy following intercourse prior to the first menstrual period (either as a result of child marriage or sexual abuse).

RISK INCREASES WITH

  • Stress.
  • Use of drugs, including anticancer drugs, cortisone.

HOW TO PREVENT

  • Don't use any drug unless prescribed for you by your doctor.
  • Reduce strenuous athletic activities.
  • Obtain medical treatment for any underlying disorder.

HOW TO DIAGNOSE

  • History and physical examination by a doctor.
  • Laboratory studies, such as Hemoglobin levels, cell counts, sugar levels, buccal smear and blood tests for hormone levels.
  • If all tests are normal, your doctor may carry out a laparoscopy

POSSIBLE COMPLICATIONS

Psychological distress about sexual development.

PROBABLE OUTCOME

The absence of menstruation is not a health risk. It is usually curable with hormone treatment or removal of the underlying cause. Most doctors are reluctant to begin treatment before 18 yr of age unless the cause can be identified and treated safely.

Uncorrectable causes include chromosomal disorders and abnormalities of the reproductive system.

TREATMENT

GENERAL MEASURES

  • Psychotherapy or counseling, if amenorrhoea is stress-related or results from eating disorders.
  • If intact hymen is the cause, minor surgery to create an opening.
  • Surgery to correct abnormalities of the reproductive system, if any.
  • If having emotional stress or conflicts, ask family, friends or competent counselors to help you resolve them.
  • Don't use stimulant or sedative drugs.
  • Take a well balanced diet and adequate rest

MEDICATION

Your doctor may prescribe a course of progesterone (hormone) tablets to induce bleeding. If bleeding begins on progesterone withdrawal, the reproductive system is functioning. This also indicates that pituitary disease is unlikely. If progesterone withdrawal does not induce bleeding, ovarian stimulants may be used for the same purpose. If you are anemic your doctor may prescribe a course of oral iron.

ACTIVITY

No restrictions. Exercise regularly, but not to excess. Sleep at least 8 hours every night.

ANY DIETARY RESTRICTIONS?

  • Eat 3 well-balanced meals a day.
  • If you believe you are overweight, consult your doctor. Don't try to lose weight by crash dieting.
  • Don't take vitamin and mineral supplements unless your doctor prescribes them.

CONTACT YOUR DOCTOR, IF

  • You are 16 years old and have never had a period.
  • Periods don't begin in 6 months, despite treatment.