AMENORRHEA

also spelled Amenorrhoea, failure to menstruate. Menstruation is the normal cyclic bleeding from the uterus in the female reproductive tract that occurs at approximately four-week intervals. Primary amenorrhea is the delay or failure to start menstruating upon reaching the age of 16, while secondary amenorrhea is the abnormal cessation of cycles once they have started. Amenorrhea is not itself a disease. It reflects some failure in the intricate balance between the hypothalamus, the pituitary, the ovaries, and the uterus. The pituitary is a gland situated deep between the two cerebral hemispheres of the brain, next to the hypothalamus, and is partially under the control of this area of brain tissue. The pituitary stimulates the ovaries by means of a hormone known as gonadotropin, which causes the ovaries to produce the reproductive hormones estrogen and progesterone. Estrogen, when released to the uterus (womb), regulates the menstrual (monthly reproductive) cycle and produces periods of bleeding if fertilization of the egg released from the ovary has not occurred. Any disturbance in this chain of events can cause amenorrhea. Hypothalamic amenorrhea is caused by emotional shock, anxiety, fear, or injuries to the midbrain. Fractures to the base of the skull or nervous-system infections such as meningitis or encephalitis may disrupt hypothalamic function, but usually the problem is psychological or emotional. Amenorrhea may be the main or the only symptom in these disturbances. Disorders that disrupt secretion by the pituitary include tumours, systemic diseases, and dietary deficiencies. When amenorrhea is primary, the reproductive organs remain infantile, the breasts do not develop, there is no pubic hair, there is dwarfism, and muscle development is deficient. When amenorrhea is secondarily caused by tumours, destructive lesions, or hemorrhagic shock, the genitals atrophy; pubic hair diminishes; there may be lethargy, weight loss, or obesity; and masculine traits may develop. Treatment is directed toward the underlying cause. The ovarian disturbances causing amenorrhea include cysts, tumours, and excessive or deficient secretion of hormones. Most of the same genital symptoms occur as with the pituitary, but the growth pattern is different. Other causes of amenorrhea include general obesity, obstructions of the vagina, and the normal bodily states of pregnancy, lactation, and menopause. Amenorrhea, if not resulting from organic disease, and infrequent menstruation do no harm to the body.