Amenorrhea During your Reproductive Years – Is It Safe? What is Amenorrhea & Its Impact on your Fertility!
Overview
What is Amenorrhea?
What Causes Amenorrhea?
- Primary Amenorrhea
- Secondary Amenorrhea
Risk Factors Associated with Amenorrhea
How do you fix your amenorrhea?
Impact of Amenorrhea on Fertility
Overview
Amenorrhea during the reproductive years is just not an uncommon occurrence. Various studies have been estimated that the prevalence of amenorrhea in the female population during the reproductive age is 1.8-3%, and up to 5% in college-aged women.
Amenorrhea may be seen as often as 20% in patients complaining about infertility. Moreover, amenorrheic women with polycystic ovaries or women with oligomenorrhea result in disordered ovarian function in the reproductive years.
Amenorrhea affects up to 5% of women in childbearing age, thereby drastically reducing their chances of getting pregnant and putting their health at risk as well.
What is Amenorrhea?
Amenorrhea is defined as the cessation or absence of menstrual period either temporarily or permanently and is a manifestation of various pathophysiological disorders.
Missing a menstrual period is rarely a sign of a serious health problem or medical condition, but amenorrhea/absence of periods for a long period of time could be a sign of a chronic condition or disease and that could be even contributing to infertility.
What causes amenorrhea?
Fluctuating levels of hormones and disorders affecting the regulatory process could lead to conditions like amenorrhea. In addition to changes in hormone levels, your menstrual cycles can be influenced by stress and chronic illness. This condition is classified as either primary or secondary amenorrhea.
Primary Amenorrhea
Primary Amenorrhea is classified in women who lack a menstrual period by the age of sixteen. It is usually a result of a genetic or anatomic condition in young women who never have menstrual periods and are not pregnant. Some of the female reproductive organs either fail to form fetal development or never attain full function in puberty.
Problems with the hypothalamus and pituitary gland could also cause primary amenorrhea as they are key for regulating ovarian hormones. Gonadal dysgenesis (premature ovaries leading to depleted follicles & eggs) is another most common cause of primary amenorrhea.
Secondary Amenorrhea
Secondary amenorrhea is the absence of periods for three consecutive cycles or for more than six months, in a female who was menstruating previously. Pregnancy is the most obvious cause of secondary amenorrhea and additional causes include conditions that affect uterus, ovaries, hypothalamus or pituitary gland.
Hypothalamic amenorrhea is caused due to the disruption of hormones by extreme weight loss, intensive exercise, severe illness, physical or emotional stress.
Other causes of secondary amenorrhea include:
- Elevated levels of androgens/male hormones
- Premature ovarian failure/early menopause
- PCOS
- Asherman’s syndrome-uterine disease that results in uterine line scarring
- Tumors or other chronic diseases that affect the pituitary gland
Risk Factors Associated with Amenorrhea
Some of the common factors that put a woman at the risk of developing amenorrhea are:
- Eating disorders
- Family history
- Excessive exercise
- Genetics
- Ovarian failure
- Thyroid disorders
- Pituitary adenoma
- Structural abnormalities
- Obesity chromosomal disorders
- Use of contraceptives
- Psychiatric disorders
Possible complications of Amenorrhea
- Thinning of bones
- Loss of fertility
How do you fix your amenorrhea?
- Hormone treatments with progesterone
- Hormone treatment using oral contraceptives
- Treating thyroid disorders
- Surgical treatment for birth defects in the reproductive system or any other physical problems
- Changes in diet and exercise
- Treatment for eating disorders
Impact of Amenorrhea on Fertility
Amenorrhea can be a symptom of an underlying condition and its causes could be varied depending on the cause. Disorders such as outflow tract (uterus & vagina), ovary disorder, pituitary and hypothalamus disorders can result in amenorrhea.
Each of the causes has a varied implication in the realm of infertility. In case of outflow tract disorders-these women could have abnormal geneital anatomy, ashrams syndrome, cervical stenosis, and endometrial damage. The fertility prospects depend on the extent of the disorder and extent of affect on the site of implantation.
Women with abnormal genital tract anatomy could be associated with obstruction at the vagina level, it is amenable to treat and fertility can be restored.
Ovarian disorders are divided into chronic anovulation and ovarian failure. In women with these ovarian disorders, natural conception is difficult as their ovarian reserve is very low or even non-existent. In such cases, treatment for underlying conditions and donor gametes could be options for pregnancy.
In hypothalamic and pituitary causes, the ovarian reserve doesn’t affect and fertility could be restored upon treatment of the cause of amenorrhea. Therefore the probability of conception in amenorrheic women is dependent on the underlying cause and each patient is evaluated and treated for fertility uniquely with respect to their condition.
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