Amenorrhoea Overview

Amenorrhoea Overview

• Amenorrhoea is the absence of menstruation.
• Classified into primary and secondary amenorrhoea.

Primary Amenorrhoea

• Refers to females who do not menstruate by age 16.

Secondary Amenorrhoea

• Defined as cessation of menstruation for over six months in a normal reproductive-aged female not due to pregnancy.

Oligomenorrhoea

• Characterized by irregular periods occurring at intervals of more than 35 days, resulting in only 4 to 9 periods per year.

Etiology of Primary Amenorrhoea

• Classified based on the presence or absence of secondary sexual characteristics.

Normal Secondary Sexual Characteristics

• Conditions include:
  • Imperforate hymen
  • Transverse vaginal septum
  • Absent vagina with a functioning uterus
  • Absent vagina with a non-functioning uterus
  • XY female with androgen insensitivity
  • Resistant ovary syndrome
  • Constitutional delay in development

Absent Secondary Sexual Characteristics (Normal Stature)

• Hypogonadotrophic hypogonadism linked to isolated gonadotrophin-releasing hormone deficiency (Kallmann syndrome).
• Hypergonadotrophic hypogonadism due to:
  • Weight loss or anorexia
  • Excessive exercise
  • Hyperprolactinemia
  • Gonadal dysgenesis
  • Turner mosaic or other X deletions
  • XY enzymatic failure
  • Ovarian failure
  • Galactosaemia

Absent Secondary Sexual Characteristics (Short Stature)

• Hyogonadotrophic hypogonadism sometimes triggered by congenital infections.
• Acquired conditions could include:
  • Trauma (e.g., head injury)
  • Empty sella syndrome
  • Tumors

Reproductive Outflow Tract Abnormalities

• Mullerian agenesis is the congenital absence of the vagina or uterus, known as Mayer-Rokitansky-Küster-Hauser syndrome.
• Typically, ovarian function and secondary sexual characteristics remain normal.
• Diagnosis may be indicated by the presence of a blind vaginal dimple and absence of the vagina and uterus.