Amenorrhea , can be either physiologic, when it occurs during pregnancy and the postpartum period (particularly when nursing), or pathologic, when it is produced by a variety of endocrinologic and anatomic disorders. In the latter circumstance, the failure to menstruate is a symptom of these various pathologic conditions. Thus, amenorrhea itself as well oligomenorrhea, are not a pathologic entity and should not be used as a final diagnosis. Although the absence of menses causes no harm to the body, in a woman who is not pregnant or postpartum it is abnormal and thus is a source of concern. For this reason women usually seek medical assistance when the condition occurs. Therefore, the clinician needs to know the various etiologies of amenorrhea, how to diagnose the etiology, and how to treat the underlying pathologic condition.
Primary amenorrhea is defined as the absence of menses in a woman who has never menstruated by the age of 16½ years. The incidence of primary amenorrhea is less than 0.1%. Many individuals with ambiguous external genitalia resulting from various intersex problems are raised as females and never menstruate. The cause of the intersex problem is usually determined at birth or soon thereafter. Although women with cryptomenorrhea caused by anatomic disorders interfering with the outflow of menses, such as an imperforate hymen or transverse vaginal septum, have the symptom of amenorrhea, they are actually menstruating. Severe systemic diseases such as metastatic carcinoma and chronic renal failure can also cause amenorrhea.
Secondary amenorrhea is defined as the absence of menses for an arbitrary time period, usually longer than 6 to 12 months. The incidence of secondary amenorrhea of more than 6 months’ duration in a survey of a general population of Swedish women of reproductive age was found to be 0.7%. The incidence was significantly higher in women younger than 25 years of age and those with a prior history of menstrual irregularity.
Menstrual irregularity are very usual and connected with different endocrinological disorders.The food intake disturbances (anorexia and bulimia) are very important matter and they can influence the female endocrinology balance.
The gynecologyst will search the etiology, diagnostic evaluation, and treatment of the various causes of both primary and secondary amenorrhea or oligomenorrhea as well as poli (many) menorrhea.
Volumes have been written on the different clinical entities associated with anovulation and menstrual disorders. Based on serum gonadotropins and ovarian hormones, clinicians are usually able to discern whether the ovulatory dysfunction is of central or ovarian origin. In the presence of PCOS, hormone levels are usually within the reference range, but they are accompanied by a wide array of clinical manifestations that may signal the presence of this disorder. Prolactin an thiroid function as well binding sex proteins provides a further informations.