It is the absence of menstrual period for more than six months during the reproductive age. If menstrual appeared at least once in the past it is then called secondary. If there has never been menstrual it is called primary amenorrhea.
We can control the causes of amenorrhea by taking detailed history, receiving vaginal swab, having a very detailed clinical examination, hormonal control, atrial or abdominal ultrasound uterine-ovarian and skull X-rays to check the pituitary. An MRI could probably provide more information if the latter case. . Additional tests are PIPEL biopsy or a trial scraping or even hysteroscopy in case of secondary amenorrhea, taking biopsies, as well as the karyotype when primary amenorrhea is present. There are women who may also have symptoms such as galactorrhoea, hirsutism, and women who have no such problems.
The causes of amenorrhea may be many, such as problems in the thyroid gland, obesity, inflammation, lack of food, damage to the pituitary gland, tumors of the ovary, adrenal gland problems, aplasia of the uterus or vagina, or both, destruction of the uterus due to inflammation, primary because of ovaries removal or destruction after surgery, total hysterectomy, chemotherapy, radiation after tumor treatment, pregnancy, menopause, breastfeeding, psychological, tumors of the central nervous system.
Treatment is usually drug based often oral contraceptives are used. Modern diagnostic methods such as hysteroscopy and taking biopsies could help us determine the exact cause and best treatment. Also various hormone tests using progesterone or clomiphene citrate and GNRH analogues could help to investigate the cause of amenorrhea.
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