Other Causes

 

Amernorrhea

Amenorrhea Definition:

Amenorrhea is a condition where in a patient ceases to have menstrual periods.  Amenorrhea may be normal under certain conditions.  Menopause, pregnancy or after a hysterectomy patients cease to have menstrual cycles; these are examples of normal or expected amenorrhea.  If you have been having pauses in your menstrual flow for more then three months you should seek out medical advice. Amenorrhea is a common cause of infertility

Primay Amenorrhea:

This condition occurs in girls who have not gotten their menstrual cycle (period) before the age of 16.

Secondary Amenorrhea:

This condition occurs in girls or women after having had menstrual cycles, then the periods stop for more then 3 months.

Understaning Amenorrhea:

To understand amenorrhea a basic understanding of the menstrual cycle must be attained.  The central nervous system controls the hypothalamus, the hypothalamus controls the pituitary gland (with GnRH), the pituitary gland controls the ovary (with FSH and LH), the hormones produced by the ovary (estrogen, progesterone) are responsible for a period to occur (menstrual flow).  For menstruation to occur the uterus has to be capable of responding to the ovarian hormones.  Lastly the anatomy has to be functioning properly.  The uterus must be healthy, the cervical canal must be open and the vaginal tract must be open for menstrual flow to occur.

When a women presents with amenorrhea the whole system must be taken into consideration.  The testing of each patient is based on the concept of compartments.  The question that is asked first is which compartment is responsible for the amenorrhea?  Is it the Hypothalamic-PItuitary axis? Is it the Pituitary-Ovarian axis? Is it the uterus / cervix / vagina?

See the Diagram Below:


                                           CNS-hypothalamus-pituitary-ovary-uterus

Conditions that can cause Amenorrhea:
Chronic anovulation:

1.  PCOS
2.  Thyroid Disease
3.  Elevated Prolactin (hyperprolactinemia)
4.  Cushing's Syndrome
5.  Androgen (male hormone) secreting tumors
6.  Ovarian Failure

Anatomic Causes:

1.  Imperforate Hymen
2.  Transverse Vaginal Septum
3.  Cervical Stenosis
4.  Mullerian Agenesis
5.  Androgen Insensitivity Syndrome
6.  Asherman Syndrome (Intrauterine Adhesions) [scarring of the uterine cavity]

Specific Conditions:

1.  Weight Loss: extreme
2.  Weight Gain: extreme
3.  Over excercise
4.  Anorexia
5.  Bulimia
6.  Low Nutrition Status
7.  Pituitary Adenomas
8.  Extreme emotional or psychological stress

Endometriosis

To better understand what endometriosis is it is important to understand what the endometrium is. The endometrium is the inner lining of the uterus. This lining grows and thickens to prepare the uterus for a possible pregnancy. When no pregnancy occurs this lining sheds (i.e. Period or menstrual flow).

In endometriosis these cells from the endometrium grow in other parts of the body (not in the uterus). They most often grow in or on other pelvic organs. Common organs that are involved are the ovaries, fallopian tubes, the outer surface of the uterus, bowel, bladder and rectum.

The endometriosis cells (endometrial cells outside the uterus) act similar to the endometrial cells (endometrial cells inside the uterus). Endometriosis cells respond to hormones in the same fashion and can even bleed (just like endometrial cells bleed during a menstrual cycle). This bleeding can cause pain and scar tissue (adhesions).

Symptoms:

Pain is the most common symptom experienced in patients with endometriosis. The most common pain symptoms are: General pelvic pain, menstrual flow pain, pre-menstrual pain, pain during intercourse, painful urination, and painful bowel movements.

Infertility is another common symptom of endometriosis. Endometriosis is commonly associated with scar tissue. This scar tissue may cause blockage of the fallopian tubes or damage the ovaries, and tubes. Read more on HSG.

Symptoms often don’t correspond with the severity of the disease. Patients with severe symptoms may have mild disease. Patients with mild symptoms may have severe disease. Some patients with endometriosis have no symptoms.

Diagnosis:

Diagnosing Endometriosis is based on symptoms and physical exam. It is usually confirmed by a procedure called Laparoscopy.

Best Treatment:

Treatments for endometriosis vary based on severity of symptoms and whether you want to have children. Treatment plans can be medical, surgical or both.

Medical:

Most often treated with NSAIDs (non-steroidal ant-inflammatory drugs) and hormones. Hormone treatment can slow the growth of endometrial cells and may also prevent new scar tissue from forming. NSAIDs are excellent pain medications that can abate the pain symptoms.

Surgical:

Surgery is often performed to remove endometriosis and any scar tissue. The most common surgical approach is laparoscopy. During the laparoscopy endometriosis is either removed or burned. This will eliminate the cells and improve the patient’s symptoms and will often help with infertility. In some severe cases a laparotomy is required (open surgery). In the most severe cases a hysterectomy is often performed with our without the removal of the ovaries.

Endometriosis can cause pain and infertility. If you have some of the symptoms described or are having difficulty getting pregnant see your doctor. The sooner endometriosis is diagnosed the sooner your symptoms can be relieved and treatment is more likely to be successful. If you have some of these symptoms and desire to have children then please see an infertility specialist as soon as possible.

Some Definitions:

Adhesions: Scar tissue that can bind together the surfaces of different organs

Endometriosis: A condition in which cells that normally line the uterine cavity are found outside the uterus. Most endometriosis is found on pelvic organs.

Infertility: a condition in which a woman or couple cannot conceive a child after 12 months of trying.

Laparoscopy: An endoscopic procedure in which a slender instrument is used to view the pelvic organs.

Laparotomy: a surgical procedure in which an incision is made in the abdomen.

Uterus: A muscular organ located in the female pelvis. It is responsible for carrying a pregnancy.