What is Primary Amenorrhoea?

Amenorrhoea is a condition in which menstrual bleeding doesn’t take place. It is a normal feature which took place at a time of pregnancy, pre puberty and post menopause. In females of reproductive age, amenorrhea is to determine the pregnancy. In the absence of pregnancy, the challenge is to find the cause of absent menstrual periods. 

In general, primary amenorrhea is the failure of puberty onset or menstrual periods until the age of 16. In the presence of normal growth and secondary sexual characteristics. If the onset of puberty such as an absence of breast development and menstrual doesn’t occur at the age of 13 then a workup for primary amenorrhea should be started. 

In easy words, we could also say that it is a condition in which first periods never occurs. It could be problem with reproductive organs, ovaries, central nervous system, and pituitary gland also. 

What are the types of Primary Amenorrhoea?

Primary amenorrhea is the absence of menstrual periods in women aged 16. It could lead to conditions such as 

Turner syndrome - in easy words it is a condition in which sex chromosomes in females are missing. It could also lead to a variety of developmental problems such as heart defects, ovaries didn’t get developed, short height. It could get diagnosed before birth or during childhood. Its signs at birth or during infancy are cardiac defects, short fingers and toes, slowed growth, broad chest with widely spaced nipples and etc. 

Vaginal atresia - it is a condition in which the vagina is closed abnormally or absent in some cases. 

Prader Willi syndrome - is a genetic syndrome which is very rare and leads to various physical, mental and behavior problems. Its symptoms may slowly change over time from childhood to adulthood. Infants have symptoms like poor muscle tone, underdeveloped genitals, poor sucking reflex, and distinct facial features. Apart from that, early childhood to adulthood have problems like weight gain, craving, cognitive impairment, speech problems, sleep disorders, vision problems, hypopigmentation, and reduced saliva flow, etc. 

Kallmann syndrome - it is a condition, in which an impaired sense of smell and absent puberty along with lack of production of certain hormones is seen. It could also be characterized by delayed puberty. 

Imperforate hymen - hymen is a thin membrane that stretches across vagina. In easy words, it is a membrane which appears like a ring with a small opening. It can teared by exercise or inserting a tampon could also tear it. Imperforate hymen include symptoms like back pain, pelvic pain, constipation, lack of menstrual cycle apart from having other puberty signs like breast development and pubic hair. 

What is the most common cause of primary amenorrhea?

Anyone who had the family history of delayed menstruation is one of the most common causes for primary amenorrhea. Genes condition that stops ovaries working properly such as Turner syndrome and high levels of testosterone. It also includes - 

1. Mullerian defects - it is a malformation of the reproductive organs, in it uterus and fallopian tubes aren’t formed as they should be. 

2. Structure problem - there must be a genital structural problem by birth. 

3. Mullerian agenesis syndrome - ovaries, breast, and clitoris are formed correctly, but there is no vaginal opening and cervix, uterus are not properly formed.

What is the most common cause of Secondary amenorrhea?

Pregnancy is the most cause for secondary amenorrhea. Other than that hypothalamic amenorrhea, ovaries, uterus or pituitary gland are other causes for the condition. 

1. Elevated levels of prolactin - a lactogenic hormone, which is produced by a pituitary gland in the brain, used to help women produce milk after childbirth. It is a kind of non cancerous tumor which produces high levels of prolactin. Its symptoms include headaches, visual impairment, nursing, painful sexual intercourse, acne which is abnormal or abnormal growth of hair on the face and body. 

2. Elevated levels of androgens - they are also called male hormones in women. Which circulates through bloodstreams and lead to acne, hirsutism, weight gain, and infertility. 

3. Polycystic ovary syndrome - it is a condition in which women produce normal than the higher amount of male hormones. This condition affects ovaries and ovulation by having cysts in the ovaries, irregular periods and high level of androgens. It is caused by inflammation, genes, and obesity. It affects the body by infertility, sleep apnea, metabolic syndrome, endometrial cancer, and depression. 

4. Early menopause - it is caused by genes, lifestyle factors, chromosome defects, autoimmune disease, and epilepsy. It has symptoms like spotting, heavy bleeding, the period after a year of no bleeding, periods longer than a week. It also has some other symptoms such as vaginal dryness, bladder control loss, hot flashes, trouble sleeping and lack of sexual desire. 

5. Tumors - it is also called a pituitary tumor which is non cancerous and interferes with hormonal regulation of periods. 

6. Hypothyroidism - in case of hormonal imbalance this kind of condition is seen. In which an underactive thyroid gland causes menstrual irregularities. 

7. Asherman’s syndrome - it comes in structural problems, in which scars tissues are seen at the lining of the uterus. This problem leads to amenorrhoea. 

8. Vaginal abnormality - a membrane or wall may prevent visible bleeding due to obstruction. 

Apart from that factors such as eating disorders, athletic training, family history, Hypothalamus can be affected by extreme weight loss, severe illness, emotional or physical stress, etc. it also has complications like infertility and osteoporosis.

What are the symptoms of Primary Amenorrhoea?

The main symptom of primary amenorrhea is lack of menstrual periods, include - 

1. Hair loss 

2. Change in Vision 

3. Additional facial hair 

4. Headache 

5. Discharge from nipple 

6. Lack of breast development are few symptoms seen in a patient affected by primary amenorrhea.

What are the treatment of Primary Amenorrhoea?

Treatment of primary amenorrhea depends upon the cause along with the patient's age and ovary function test. Its treatment results are seen after a long period of time. In case of late menstrual periods family history, periods may occur on time. 

In the case of physical or genetic problems, surgery is required. There is no guarantee for it as well. In the treatment of primary amenorrhea, the goal is to relieve from the symptoms such as hormonal imbalance, achieve fertility, establishing menstruation is done.