Amenorrhoea (BE), amenorrhea (AmE), or amenorrhœa, is the absence of a menstrual period in a woman of reproductive age. Physiologic states of amenorrhoea are seen during pregnancy and lactation (breastfeeding), the latter also forming the basis of a form of contraception known as the lactational amenorrhea method. Outside of the reproductive years there is absence of menses during childhood and after menopause. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... British English (BrE, BE, en-GB) is the broad term used to distinguish the forms of the English language used in the United Kingdom from forms used elsewhere in the Anglophone world. ... For other uses, see American English (disambiguation). ... The menstrual cycle is the periodic change in a womans body that occurs every month between puberty and menopause and that relates to reproduction. ... This article is about human pregnancy in biological females. ... An infant breastfeeding International Breastfeeding Symbol (Matt Daigle, Mothering magazine contest winner 2006) Breastfeeding is the feeding of an infant or young child with milk from a womans breasts. ... Natural family planning (NFP), sometimes described as periodic abstinence, is a form of birth control that involves recognizing the natural signs in a womans fertility. ... Menopause is the physiological cessation of menstrual cycles associated with advancing age in women. ...

Amenorrhoea is a symptom with many potential causes. Primary amenorrhoea (menstruation cycles never starting) may be caused by developmental problems such as the congenital absence of the uterus, or failure of the ovary to receive or maintain egg cells. Also, delay in pubertal development will lead to primary amenorrhoea. Secondary amenorrhoea (menstruation cycles ceasing) is often caused by hormonal disturbances from the hypothalamus and the pituitary gland or from premature menopause, or intrauterine scar formation. // For ovary as part of plants see ovary (plants) An ovary is an egg-producing reproductive organ found in female organisms. ... For the video-related acronym, see OVA. A human ovum An ovum (or loosely, egg or egg cell) is a female sex cell or gamete. ... The hypothalamus links the nervous system to the endocrine system via the pituitary gland (hypophysis). ... The pituitary gland, or hypophysis, is an endocrine gland about the size of a pea that sits in a small, bony cavity (sella turcica) covered by a dural fold (sellar diaphragm) at the base of the brain. ... Menopause is the physiological cessation of menstrual cycles associated with advancing age in women. ...

Etymology and history

The term is derived from Greek: a = negative, men = month, rhoia = flow. Derived adjectives are amenorrhoeal and amenorrheic. The opposite is the normal menstrual period. The menstrual cycle is the periodic change in a womans body that occurs every month between puberty and menopause and that relates to reproduction. ...

Historically, the term amenorrhoea has often been used as a euphemism for "unwanted pregnancy" and many folk treatments for this condition are in fact abortifacients. Pregnancy, as noted, is only one potential cause for amenorrhea; sometimes pseudo-pregnancy can be a cause for this as well.^{[citation needed]} Euphemism is the substitution of an agreeable or inoffensive expression for one that may offend or suggest something unpleasant to the listener; or in the case of doublespeak, to make it less troublesome for the speaker. ... An abortifacient is a substance that induces abortion. ... Pseudocyesis also known as false pregnancy, can cause many of the signs and symptoms associated with pregnancy, and can resemble the condition in every way except for fetal presence. ...

Classification of amenorrhoea

Types of amenorrhoea is diagnosed based on several factors which include the age of onset, and level of hormonal involvement.

Age of onset

There are two types of amenorrhea: primary and secondary amenorrhea. Primary amenorrhoea is the absence of menstruation in a woman by the age of 16. Also, as pubertal changes precede the first period, menarche, women who have no sign of thelarche or pubarche and thus are without evidence of initiation of puberty by the age of 14 have primary amenorrhoea. (Reference: Speroff L et al, Clinical Gynecologic Endocrinology and Infertility, 1999) Menarche (IPA: ) is the first menstrual period, or first menstrual bleeding in the females of human beings. ... Thelarche is the first stage of secondary (postnatal) breast development, usually occurring at the beginning of puberty in girls. ... Pubarche refers to the first appearance of pubic hair in a child. ... Puberty refers to the process of physical changes by which a childs body becomes an adult body capable of reproduction. ...

Secondary amenorrhoea is where an established menstruation has ceased - for three months in a woman with a history of regular cyclic bleeding, or six months in a woman with a history of irregular periods.

Primary amenorrhoea

1. Gonadal dysgenesis, including Turner Syndrome.
2. Mullerian agenesis (Mayer-von-Rokitansky-Küster-Hauser syndrome (MRKH)).
3. Androgen insensitivity syndrome.
4. Delay in hypothalamic-pituitary maturation.
5. Olfacto-genital dysplasia, Kallmann syndrome.
6. Vaginal obstruction, cryptomenorrhea, imperforate hymen.
7. Receptor abnormalities for FSH, LH.
8. Specific forms of congenital adrenal hyperplasia
9. Swyer syndrome
10. Galactosemia
11. Aromatase deficiency
12. Prader-Willi syndrome
13. Male pseudo-hermaphroditism (about 1 in every 150,000 births)

Mullerian agenesis refers to a condition in a female where the mullerian ducts fail to develop and a uterus will not be present. ... Androgen insensitivity syndrome (AIS, or Androgen resistance syndrome) is a set of disorders of sexual differentiation that results from mutations of the gene encoding the androgen receptor. ... Kallmann syndrome is an example of hypogonadism (decreased functioning of the sex hormone-producing glands) caused by a deficiency of gonadotropin-releasing hormone (GnRH), which is created by the hypothalamus. ... Cryptomenorrhea is a condition where menstruation occurs but is not visible due to an obstruction of the outflow tract. ... An imperforate hymen is a condition where the hymen completely obstructs the vagina. ... Congenital adrenal hyperplasia (CAH) refers to any of several autosomal recessive diseases resulting from defects in steps of the synthesis of cortisol from cholesterol by the adrenal glands. ... Swyer syndrome, or XY gonadal dysgenesis, is a type of female hypogonadism in which no functional gonads are present to induce puberty in an otherwise normal girl whose karyotype is then found to be XY. Her gonads are found to be nonfunctional streaks. ... Galactosemia is a rare genetic metabolic disorder which affects an individuals ability to properly digest the sugar galactose. ... Aromatase belongs to the group of cytochrome P450 enzymes (EC 1. ... Prader-Willi syndrome is a genetic disorder, in which seven genes (or some subset thereof) on chromosome 15 are missing or unexpressed (chromosome 15q partial deletion) on the paternal chromosome. ... An intersexual is a person (or individual of any unisexual species) who is born with genitalia and/or secondary sexual characteristics of indeterminate sex, or which combine features of both sexes. ...

Secondary amenorrhoea

1. Pregnancy
2. Anovulation
3. Menopause
4. Premature menopause
5. Hypothalamic-pituitary dysfunction, including
   1. Exercise amenorrhoea, related to excessive physical exercise
   2. Stress amenorrhoea,
   3. Eating disorders and weight loss (obesity, anorexia nervosa, or bulimia)
6. Hyperprolactinemia (elevated prolactin levels)
7. Polycystic ovary syndrome (PCO-S)
8. Androgen producing tumor (i.e arrhenoblastoma)
9. Intrauterine adhesions (Asherman's Syndrome)
10. Thyroid dysfunction
11. Hemochromatosis
12. Drug-induced

This article is about human pregnancy in biological females. ... In medicine, anovulation is absence of ovulation when it would be normally expected (in a post-menarchal, premenopausal woman). ... Menopause is the physiological cessation of menstrual cycles associated with advancing age in women. ... Menopause (also known as the Change of life or climacteric) is a stage of the human female reproductive cycle that occurs as the ovaries stop producing estrogen, causing the reproductive system to gradually shut down. ... Hypothalamic-pituitary dysfunction is a term to describe a nonorganic relative inactivity of the gonadotropin-releasing hormone (GnRH) system of the hypothalamus and its dependent pituitary gonadotrophs that normally produce follicle stimulating hormone, FSH, and luteinizing hormone, LH. The condition occurs during the reproductive years and leads to hypogonadotropic hypogonadism. ... U.S. Marine emerging from the swim portion of a triathlon. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... For the symphonic black metal band, see Anorexia Nervosa (band) For other uses, see Anorexia Anorexia nervosa is a psychiatric diagnosis that describes an eating disorder characterized by low body weight and body image distortion with an obsessive fear of gaining weight. ... Bulimia nervosa, more commonly known as bulimia, is a psychological condition in which the subject engages in recurrent binge eating followed by intentionally doing one or more of the following in order to compensate for the intake of the food and prevent weight gain: vomiting inappropriate use of laxatives, enemas... Prolactin is a hormone secreted by lactotropes in the adenohypophysis (anterior pituitary gland) which is made up of 199 amino acids with a molecular weight of about 23,000 daltons. ... Prolactin (PRL) is a peptide hormone primarily associated with lactation. ... Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects approximately one in ten women. ... The arrhenoblastoma is a rare ovarian stromal neoplasm that secretes testosterone. ... Ashermans syndrome , also called uterine synechiae, presents a condition characterized by the presence of scars within the uterine cavity. ... Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ...

Hormonal involvement

Hypogonadotropic amenorrhoea refers to conditions where there are very low levels of serum FSH and LH. Generally, inadequate levels of these hormones lead to inadequately stimulated ovaries who then fail to produce enough estrogen to stimulate the endometrium (uterine lining), hence amenorrhoea. This is typical for conditions of pubertal delay, hypothalamic or pituitary dysfunction. In general, women with hypogonadotropic amenorrhoea are potentially fertile. Follicle stimulating hormone (FSH) is a hormone produced by gonadotropes in the anterior pituitary gland. ... LH, Lh, or lh may stand for: Left-handed or left hand Lernout & Hauspie, a Belgium-based speech and language technology leader company Luteinizing hormone, a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland Lufthansa (IATA airline designator), the largest German airline Love Hina... Estriol. ... The endometrium is the inner membrane of the mammalian uterus. ...

Hypergonadotropic amenorrhoea refers to conditions with high levels of FSH (and LH). FSH levels are typically in the menopausal range. This implies that the ovary or gonad does not respond to pituitary stimulation. Gonadal dysgenesis or premature menopause are possible causes. Chromosome testing is usually indicated in younger individuals with hypergonadotropic amenorrhoea. Follicle stimulating hormone (FSH) is a hormone produced by gonadotropes in the anterior pituitary gland. ... LH, Lh, or lh may stand for: Left-handed or left hand Lernout & Hauspie, a Belgium-based speech and language technology leader company Luteinizing hormone, a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland Lufthansa (IATA airline designator), the largest German airline Love Hina... // For ovary as part of plants see ovary (plants) An ovary is an egg-producing reproductive organ found in female organisms. ... The gonad is the organ that makes gametes. ... Figure 1: A representation of a condensed eukaryotic chromosome, as seen during cell division. ...

In normogonadotropic amenorrhoea, FSH levels are in the normal range. This would suggest that the hypothalamic-pituitary-ovarian axis is functional. Amenorrhoea may be due to outflow obstruction, or abnormal ovarian regulation or excess androgens as seen in polycystic ovary syndrome.

Cushing's Disease/Syndrome can also cause amenorrhoea due to excessive amounts of cortisol in the blood stream.

Specific types of amenorrhoea

Exercise amenorrhoea

Female athletes or women who perform considerable amounts of exercise on a regular basis are at risk of developing 'athletic' amenorrhoea. It was thought for many years that low body fat levels and exercise related chemicals (such as beta endorphins and catecholamines) disrupt the interplay of the sex hormones estrogen and progesterone. However recent studies have shown that there are no differences in the body composition, or hormonal levels in amenorrheic athletes. Instead, amenorrhea has been shown to be directly attributable to a low energy availability. Many women who exercise at a high level do not take in enough calories to expend on their exercise as well as to maintain their normal menstrual cycles. [1]

A second serious risk factor of amenorrhea is severe bone loss sometimes resulting in osteoporosis and osteopenia. It is the third component of an increasingly common disease known as female athlete triad syndrome. The other two components of this syndrome are osteoporosis and disordered eating. Awareness and intervention can usually prevent this occurrence in most female athletes. Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... Osteopenia is a decrease in bone mineral density that can be a precursor condition to osteoporosis. ... There are very few or no other articles that link to this one. ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ... In biological psychology, awareness describes a human or animals perception and cognitive reaction to a condition or event. ...

High risk sports

• Ballet
• Track and Field
• Swimming
• Cycling
• Rowing
• Diving
• Figure skating
• Gymnastics
• all other intense and strenuous sports

Drug-induced amenorrhea

Certain medications, particularly contraceptive medications, can induce amenorrhoea in a healthy woman. The lack of menstruation usually begins shortly after beginning the medication and can take up to a year to resume after stopping a medication. Hormonal contraceptives that contain only progestogen like the oral contraceptive Micronor, and especially higher-dose formulations like the injectable Depo Provera commonly induce this side-effect. Recently, an extended cycle combined oral contraceptive pill which aims to purposefully induce amenorrhea (Lybrel), has been approved by the FDA. Progestogen Only Pills or Progestin Only Pills (POP) are contraceptive pills that only contain synthetic progestogens (progestins) and do not contain oestrogen. ... Depot medroxyprogesterone acetate (DMPA) is a progestogen-only hormonal contraceptive birth control drug which is injected every 3 months. ... Look up side effect in Wiktionary, the free dictionary. ... Extended cycle combined oral contraceptive pills are COCPs packaged to reduce or eliminate the withdrawal bleeding that occurs once every 28 days in traditionally packaged COCPs. ... The United States Food and Drug Administration is the government agency responsible for regulating food, dietary supplements, drugs, cosmetics, medical devices, biologics and blood products in the United States. ...

Treatments

Treatments vary based on the underlying condition. Key issues are problems of surgical correction if appropriate and estrogen therapy if estrogen levels are low.

For those who do not plan to have biological children, treatment may be unnecessary if the underlying cause of the amenorrhoea is not threatening to her health.

Unless receiving eggs from an egg donor, a woman is unable to conceive while she is amenorrhoeic. On the other hand, 'athletic' and drug-induced amenorrhoea has no effect on long term fertility as long as menstruation can recommence. The best way to treat 'athletic' amenorrhoea is to decrease the amount and intensity of exercise. Similarly, to treat drug-induced amenorrhoea, stopping the medication on the advice of a doctor is a usual course of action. An egg donor is a woman who provides usually several eggs (ova, oocytes) for another person or couple who want to have a child. ...

External links

• Disability Online's amenorrhoea page
• Disability Online's athletic amenorrhoea page
• CureZone, Amenorrhoea