Drug-induced
editAnti-psychotic drugs used to treat schizophrenia have been known to cause amenorrhoea as well. New research suggests that adding a dosage of Metformin to an anti-psychotic drug regimen can restore menstruation.[1] Metformin decreases resistance to the hormone insulin, as well as levels of prolactin, testosterone, and lutenizing hormone (LH). Metformin also decreases the LH/FSH ratio. Results of the study on Metformin further implicate the regulation of these hormones as a main cause of secondary amenorrhoea.
Physical
editAmenorrhea can also be caused by physical deformities. One example of this is Mayer–Rokitansky–Küster–Hauser syndrome, the second-most common cause of primary amenorrhea.[2] The syndrome is characterized by Müllerian agenesis. In MRKH Syndrome, the Müllerian ducts do not develop, which prevents menstruation. The syndrome usually develops during the first trimester of pregnancy. MRI techniques can be helpful in determining the extent of the problem. Women may recover from MRKH syndrome, but other times primary amenorrhea, which is characteristic of the disorder, may prevent pregnancy for life.
Women with eating disorders, such as anorexia nervosa are likely to suffer from secondary amenorrhoea. This can be attributed to low levels of the hormone leptin. [3] A critical leptin level is necessary to maintain regular menstrual cycles, and eating disorders decrease the amount of leptin circulating in a woman's body.
Lactational
editBreastfeeding is a common cause of secondary amenorrhea, and often the condition lasts for over six months. [4] Breastfeeding typically lasts longer than lactational amenorrhea, and the duration of amenorrhea varies depending on how often a women breastfeeds.[5] Lactational amenorrhea has been advocated as a method of family planning, especially in developing countries where access to other methods of contraception may be limited. Breastfeeding is said to prevent more births in the developing world than any other method of birth control or contraception. Lactational amenorrhea is 98% percent effective as a method of preventing pregnancy in the first six months postpartum.[6]
Diagnosis
editDiagnosing Primary Amenorrhea
editPrimary amenorrhea can be diagnosed in women by age 14 if no secondary sex characteristics are present.[7] In the absence of secondary sex characteristics, the most common cause of amenorrhea is low levels of FSH and LH caused by a delay in puberty. Gonadal dysgenesis, often associated with Turner's Syndrome, or premature ovarian failure may also be to blame. If secondary sex characteristics are present, but menstruation is not, primary amenorrhea can be diagnosed by age 16. A reason for this occurrence may be that a person phenotypically female but genetically male, a situation known as androgen insensitivity syndrome. If undescended testes are present, they are often removed because there are health risks associated with their presence. In the absence of undescended testes, an MRI can be used to determine whether or not a uterus is present. Müllerian agenesis causes around 15% of primary amenorrhea cases. If a uterus is present, outflow track obstruction may be to blame for primary amenorrhea.
Diagnosing Secondary Amenorrhea
editSecondary amenorrhea's most common and most easily diagnosable causes are pregnancy, thyroid disease, and hyperprolactinemia. A pregnancy test is a common first step for diagnosis.[8] Hyperprolactinemia, characterized by high levels of the hormone prolactin, is often associated with a pituitary tumor. A dopamine agonist can often help relieve symptoms. The subsiding of the causal syndrome is usually enough to restore menses after a few months. Secondary amenorrhea may also be caused by outflow track obstruction, often related to Asherman's Syndrome. Polycystic ovary syndrome can cause secondary amenorrhea, although the link between the two is not well understood. Ovarian failure related to early onset menopause can cause secondary amenorrhea, and although the condition can usually be treated, it is not always reversible. Secondary amenorrhea is also caused by stress, extreme weight loss, and excessive exercise. Young athletes are particularly vulnerable, although normal menses usually return with healthy body weight. Causes of secondary amenorrhea can also result in primary amenorrhea, especially if present before onset of menarche. [9][10]
Information added in response to Peer Review
editon Contraceptives
editPatients who use and then cease using contraceptives like the combined oral contraceptive pill may experience secondary amenorrhea as a withdrawal symptom. [11] The link is not well understood, as studies have found no difference in hormone levels between women who develop amenorrhea as a withdrawal sympton following the cessation of OCOP use and women who experience secondary amenorrhea because of other reasons.[12] New contraceptive pills, like continuous oral contraceptive pills (OCPs) which do not have the normal 7 days of placebo pills in each cycle, have been shown to increase rates of amenorrhea in women. Studies show that women are most likely to experience amenorrhea after 1 year of treatment with continuous OCP use. [13]
on Social Effects
editThe social effects of amenorrhea on a person vary significantly. Amenorrhea is often associated with anorexia nervosa and other eating disorders, which have their own effects. If secondary amenorrhea is triggered early in life, for example through excessive exercise or weight loss, menarche may not return later in life. A woman in this situation may be unable to become pregnant, even with the help of drugs. Long-term amenorrhea leads to an estrogen deficiency which can bring about menopause at an early age. The hormone estrogen plays a significant role in regulating calcium loss after ages 25-30. When her ovaries no longer produce estrogen because of amenorrhea, a woman is more likely to suffer rapid calcium loss, which in turn can lead to osteoporosis. [14] Increased testosterone levels cause by amenorrhea may lead to body hair growth and decreased breast size. [15] Increased levels of androgens, especially testosterone, can also lead to ovarian cysts. Some research among amenorrheic runners indicates that the loss of menses may be accompanied by a loss of self-esteem.[16]
- ^ Wu, RR (2012 Aug 1). "Metformin for treatment of antipsychotic-induced amenorrhea and weight gain in women with first-episode schizophrenia: a double-blind, randomized, placebo-controlled study". The American Journal of Psychiatry. 169 (8): 813–21. doi:10.1176/appi.ajp.2012.11091432. PMID 22711171.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Rousset, P.; Raudrant, D.; Peyron, N.; Buy, J. N.; Valette, P. J.; Hoeffel, C. (2013 Sep). "Ultrasonography and MRI features of the Mayer-Rokitansky-Küster-Hauser syndrome". Clinical Radiology. 68 (9): 945–52. doi:10.1016/j.crad.2013.04.005. PMID 23725784.
{{cite journal}}: Check date values in:|date=(help) - ^ Köpp, W.; Blum, W. F.; von Prittwitz, S.; Ziegler, A.; Lübbert, H.; Emons, G.; Herzog, W.; Herpertz, S.; Deter, H. C.; Remschmidt, H.; Hebebrand, J. (1997 Jul). "Low leptin levels predict amenorrhea in underweight and eating disordered females". Molecular Psychiatry. 2 (4): 335–40. doi:10.1038/sj.mp.4000287. PMID 9246675. S2CID 22722441.
{{cite journal}}: Check date values in:|date=(help) - ^ Lewis, PR (1991 Mar). "The resumption of ovulation and menstruation in a well-nourished population of women breastfeeding for an extended period of time". Fertility and Sterility. 55 (3): 529–36. doi:10.1016/S0015-0282(16)54180-6. PMID 2001754.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help)CS1 maint: date and year (link) - ^ Labbok, M. "Physiology of lactational amenorrhea and its implications for spacing of pregnancies".
- ^ Kennedy, Kathy (April–May 1990). "Lactation and contraception" (PDF). Ginecologla y Obstetricia de Mexico. 58 (1): 25–34. PMID 2276655.
{{cite journal}}: CS1 maint: date and year (link) CS1 maint: date format (link) - ^ Master-Hunter, Tarannum (April 2006). "Amenorrhea: Evaluation and Treatment". American Family Physician. 8. 73 (8): 1374–1382. PMID 16669559.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help)CS1 maint: date and year (link) - ^ Welt, Corrine. "Etiology, diagnosis, and treatment of secondary amenorrhea".
- ^ Newson, Louise. "Amenorrhoea".
- ^ Welt, Corrine K. "Etiology, diagnosis, and treatment of primary amenorrhea".
- ^ Willacy, Hayley. "Combined Oral Contraceptive (Follow-up and Common Problems)".
- ^ Weisberg, E (1982 Dec). "Fertility after discontinuation of oral contraceptives". Clinical Reproduction and Fertility. 1 (4): 261–72. PMID 6764883.
{{cite journal}}: Check date values in:|date=(help) - ^ Wright, KP (2008 Oct). "Evaluation of extended and continuous use oral contraceptives". Therapeutics and Clinical Risk Management. 4 (5): 905–11. doi:10.2147/tcrm.s2143. PMC 2621397. PMID 19209272.
{{cite journal}}: Check date values in:|date=(help); Unknown parameter|coauthors=ignored (|author=suggested) (help)CS1 maint: unflagged free DOI (link) - ^ Konstantinovsky, Michelle. "Amenorrhea: Dieting to the extreme".
- ^ Hickson, Anna-Sofie. "Amenorrhea Side Effects".
- ^ Comenitz, Linda (1983). "The psychological effects of secondary amenorrhea in women runners". Clinical Social Work Journal. 11 (1): 87–96. doi:10.1007/BF00755658. S2CID 143591523.