WOMEN: MENSTRUAL PROBLEMS. ABSENCE OF PERIODS (AMENORRHOEA)
Primary amenorrhoea is the failure to start menstruating during puberty. When a woman stops menstruating at any time between the menarche and the menopause, it’s called secondary amenonhoea.
Primary amenorrhoea
Ninety-five per cent of girls have had their first period by the age of 16 years. Those who haven’t started menstruating by this age (earlier if there’ve been no other signs of puberty by the age of 14) should see their doctor to discover if there is any particular problem that needs correcting. Many will just be ‘late starters’, but it’s important to treat the following causes of primary amenorrhoea.
Underweight Sometimes failure to start menstruating is an important clue to anorexia nervosa, and this should always be suspected if menstruation hasn’t started or has stopped in a young woman who is extremely thin.
Imperforate hymen
Hormonal disturbances Many hormonal disturbances can lead to primary amenorrhoea.
• If the hypothalamus or pituitary glands are underactive, all the developments of puberty will be delayed or disturbed
• If the ovaries can’t respond to pituitary hormones, there may be a growl spurt but secondary sexual characteristics won’t develop without ovarian hormones.
• Underactivity of the thyroid gland (hypothyroidism) usually results in disturbed puberty and delayed menarche
• Overactivity of the adrenal glands (adrenal hyperplasia) can lead to an over production of male hormones that counteract ovarian hormones.
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