Primary amenorrhea
Primary Amenorrhea can be considered as either the Absence of menstrual period by the age of 14 years when the secondary sexual characteristics do not develop.
OR
Absence of menstruation by 16 years of age regardless of the presence of normal growth and development of secondary sexual characteristics.
PATHOPHYSIOLOGY OF MENSTRUAL BLEEDING
The levels of oestrogen in the body stimulate the proliferation of endometrium.
After ovulation, the Corpus luteum develops and starts to produce the hormone progesterone which causes the transformation of the proliferating endometrium into secretory.
In the absence of pregnancy, the secretory endometrium sheds in the form of menstrual bleeding.
Causes of Primary Amenorrhoea
- DISORDERS OF THE OUTFLOW TRACT (UTERUS AND VAGINA) It includes:
- Imperforate hymen
- Mullerian agenesis
- Cervical agenesis
- Transverse vaginal septum
- Asher man’s syndrome.
- DISORDERS OF OVARY
- Gonadal dysgenesis
- Resistant ovary syndrome
- Enzyme deficiencies: 17 α hydroxylase, aromatase
DISORDERS OF ANTERIOR PITUITARY
It includes Congenital disorders like
- Hypopituitarism
- Isolated FSH deficiency.
- Acquired disorders include pituitary adenomas, drug induced hyper prolactinemia,hypothyroidism.
DISORDERS OFHYPOTHALAMUS
It includes Congenital Kallmann syndrome, anorexianervosa, extreme exercise, stress and obesity, constitutional delay.
Diagnosis for Primary Amenorrhea
- MRI – for identifying if there are any issues with the pituitary gland.
- Lab tests – Thyroid function test, Ovary function test, Prolactin test, Male hormone test.
- Ultrasound or CT scans help identifying any abnormalities in the reproductive organs.
Treatment for Primary Amenorrhea
Treatment of primary amenorrhoea is based on the cause for primary amenorrhea. Amenorrhoea is not a disease.It is displaying an underlying issue that needs to be corrected.
What are the effects of Primary Amenorrhea?
Infertility is a complication of Primary Amenorrhea. Later in life, girls with amenorrhoea develop osteoporosis. It is advisable to all parents to keep a track of the changes that occur in a girl after she has crossed 11 years. In case of delay in the attainment of mensuration or development of secondary sexual characteristics then we need to determine the underlying cause and work to rectify it as early as possible.
About Dr. Rashmi Sharma
Dr. Rashmi Sharma is an IVF specialist Consultant Reproductive Medicine and Director Origyn Fertility & IVF New Delhi MBBS (BHU), MD(BHU), DNB, MNAMS, FICOG, Diploma IVF and reproductive Medicine (Kiel University, Germany) Web Editor, Indian Fertility Society (2024-26) Former HOD, IVF dept, Moolchand Hospital, Delhi (2009-13) and Max Hospital, Pitampura, Delhi (2013-17), Director, Origyn Fertility & IVF, which has 4 branches across Delhi.
Origyn IVF has been accredited for 1-year fellowship in IVF and reproductive medicine along with an MSc in Clinical Embryology under Amity University and IFS Collaboration. Recipient of the “C. S. Dawn Award” for best paper presentation on her work on IVF /ICSI with genital tuberculosis, at All India Congress Of Obstetrics and Gynecology (AICOG 2010) Recipient of “Hall of Fame – Best IVF specialist in India – North” at Economic Times – National Fertility Awards,2019 and 2023 & 2024.
Origyn IVF received “Best IVF center in North India” and “Most integrated team in IVF, India – North” at Economic Times – National Fertility Awards, 2019 & 2024 Recipient of “Best IFS Executive” at Fertivision – 2018, Kochi. Authored various chapters in infertility books of repute. Many national and international paper presentations and publications.
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