Primary amenorrhea can be defined as amenorrhea (failure menstruation to begin) at the age of 16 years or amenorrhea at the age of 14 years in presence of well developed secondary female characters.
There are many causes of primary pathological amenorrhea and they are given below:
- Primary pathological amenorrhea can be there in presence of congenital obstruction of lower genital tract like non canalization of cervix, vagina and imperforate hymen that leads to cryptomenorrhea (occurrence of menstrual symptom without external bleeding). Cryptomenorrhea is not actual primary amenorrhea as the patient is actually menstruating without external visible bleeding.
- Congenital absence of uterus and gross hypoplasia of uterus can cause amenorrhea.
- In Turner’s syndrome due to congenital aplasia of ovaries (streak ovary).
- Inter sexuality like pseudohermaphroditism can cause pathological primary amenorrhea.
- Hypothyroid cretinism, hypopituitary dwarfism and hypothalamic gonadotropin releasing hormone deficiency cause primary pathological amenorrhea.
- Organic brain lesions like brain tumors and infection in the brain can lead to primary amenorrhea.
- Some times delayed puberty is cause of primary amenorrhea.
- Kallman syndrome, Rokitansky-Hauser-Kuster symdrome etc can cause primary pathological amenorrhea.
All these are causes of primary pathological amenorrhea.
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Amenorrhea is absence of menstruation in a woman. There are many causes of secondary pathological amenorrhea and they are listed below:
- Obstruction (acquired) to the lower genital tract -lower genital tract injury due to operation, chemical burns etc. which can lead to stenosis (narrowing) of cervix and rarely of vagina.
- Ovarian factors of secondary pathological amenorrhea:
- Polycystic ovarian disease formerly known as Stein-Leventhal syndrome; hyperthecosis ovarii etc.
- Ovarian failure or hypo hormonal amenorrhea.
- Hyper hormonal amenorrhea-due to excess estrogen as seen in metropathia hemorrhagica and may be due to therapeutic use of hormone.
- Ovarian destruction of ovaries by disease (rare cause), radiation or surgical removal of ovaries known as oophorectomy.
- Premature menopause due to auto immune disease or due to ovarian resistance syndrome.
- Masculinizing tumors of ovaries like arrhenoblastoma, adrenal like tumors, hillus cell tumor, masculinizing luteoma etc.
- Hysterectomy or surgical removal of uterus.
- Destruction of endometrium of uterus due to-genital tuberculosis, attachment due to excess and vigorous curettage after abortion, or due to intra cavity introduction of radium in uterus.
- Basophil adenoma-Cushing’s disease.
- Acidophil tumor- which produce gigantism and acromegaly.
- Oral contraceptive pills and psychotropic drugs that cause hyperprolactinemia.
- Pituitary failure due to cyst, post partum pituitary necrosis (Sheehan’s syndrome), chromophobe adenoma, Simmond’s disease etc.
- Prolactinoma causing hormonal disturbance.
- Psychogenic causes- anorexia nervosa, stress, pituitary shock, vigorous exercise, pseudocyesis etc.
- Suppression of FSH (follicle stimulating hormone) due to persistence of luteotropic hormone as seen in Chiari-Frommel syndrome. Read more…