Evaluation and management of adolescent amenorrhea

Abstract

During the first years of menstruation it is not rare for a girl to present with an irregular menstrual pattern. The complete absence or cessation of menses, which is defined as amenorrhea, requires careful evaluation and management. It is divided into primary and secondary types that describe the occurrence of amenorrhea before and after menarche, respectively. The list of causes is long and includes anatomical or functional anomalies of the genital tract, hormonal disorders, and multifactorial reasons. The most common causes are hypothalamic amenorrhea, polycystic ovarian syndrome, hyperprolactinemia, and ovarian failure. A thorough medical history and careful clinical examination of the young girl is absolutely essential. The distinction between primary and secondary amenorrhea, together with the presence, or not, of secondary sexual characteristic development will guide the physician to the differential diagnosis of amenorrhea. Essential laboratory examinations include follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), and prolactin measurements; while in the presence of acne or hirsutism, androgen levels should also be measured. Management should focus on the restoration of ovulatory cycles and the prevention of short- and long-term consequences of hormonal imbalance.

A genetically female brain is required for a regular reproductive cycle in chicken brain chimeras

“…(9) ARTICLE women are associated with a number of reproductive disorders including hypothalamic hypogonadism, hyperprolactinemia, polycystic ovarian syndrome and ovarian failure 47,48 . In addition, polymorphisms in human clock genes might influence human fertility.…”

Czynnościowy podwzgórzowy brak miesiączki – trudności diagnostyczne, monitorowanie i leczenie

“…Czynnościowa hiperprolaktynemia, możli-wa do potwierdzenia w testach dynamicznych z MCP lub TRH, skutkuje zaburzeniami ośrodkowymi, w tym zakłóceniem pulsacyjnego wydzielania LH i amplitudy pulsów tego hormonu. W następstwie wymienionych powyżej zmian dochodzi do upośledzenia proliferacji komórek ziarnistych oraz spadku syntezy i wydzielania estradiolu; dodatkowo, brak wzrostu stężenia LH prowadzi do zahamowania wzrostu pęcherzyków jajnikowych oraz braku owulacji [24]. Ponadto w wyniku działania stresu dochodzi do wtórnego wzrostu stężenia ACTH, katecholamin i kortyzolu [25,26].…”

“…The functional hyperprolactinaemia, which can be confirmed during dynamic tests with metoclopramide or thyrotropinreleasing hormone, is reflected by central disorders, including impairment of pulsatile release of LH, and LH-pulse amplitude. The abovementioned alterations result in impaired proliferation of the granulosa cells and decreased synthesis and secretion of oestradiol; additionally, lack of LH peaks leads to inhibition of ovarian follicle growth and anovulation [24]. Moreover, the exposure to stress results in a secondary increase in concentrations of ACTH, catecholamines, and cortisol [25,26].…”

Reproductive Health Care of Adolescent Women

“…43 A thorough history is one of the most important Primary amenorrhea is defined as a lack of menstruation in a 14-year-old girl with no secondary sexual characteristics or in a 16-year-old girl with secondary sexual characteristics. 44 The most common causes of amenorrhea in adolescents are hypothalamic amenorrhea, polycystic ovarian syndrome, hyperprolactinemia, and ovarian failure. 47 Other etiologies to consider include adrenal and ovarian tumors, drug effects, congenital adrenal hyperplasia, physical or emotional stress, anorexia nervosa, and the female athlete triad.…”