Amenorrhea

Target Pituitary

What is Amenorrhea?

Amenorrhea is the absence of menstrual cycles.

Amenorrhea is called primary when a woman has not started to menstruate by the age of 16 years, while secondary amenorrhea refers to the abnormal cessation of menstruation in a woman who previously has had menstrual cycles.

In amenorrheic women, the levels of female reproductive hormones are not sufficient to stimulate menstruation. This condition is sometimes associated with malnutrition, such as that which occurs in anorexia nervosa, or with extreme exercise, which puts excessive nutritional and other demands on the body. An association between stress and amenorrhea has also been demonstrated. Amenorrhea may also result from potentially serious disorders of the ovaries, the hypothalamus, or the pituitary gland; therefore, a physician should always evaluate chronic absence of menstrual cycles.

Prolonged amenorrhea can result in early bone loss and increased risk of osteoporosis. Amenorrhea occurs naturally in some women who are breast-feeding, but in these circumstances it does not put the bones at risk.

Potential pituitary causes of amenorrhea include pituitary tumors, such as prolactinomas, which secrete hormones which directly affect the menstrual cycle. Hormone secretion by pituitary tumors in patient with Cushing's disease or acromegaly can also cause amenorrhea. Any tumor compressing the normal pituitary gland can also affect reproductive function.



Amenorrhea Information

Target Pituitary

  • What are the symptoms?
    ...

    By definition, the symptom of amenorrhea is absence of menstrual periods.


  • What are the causes?
    ...

    Potential pituitary causes of amenorrhea include pituitary tumors, such as prolactinomas, which secrete hormones which directly affect the menstrual cycle. Hormone secretion by pituitary tumors in patient with Cushing's disease or acromegaly can also cause amenorrhea. Any tumor compressing the normal pituitary gland can also affect reproductive function.


  • Complications
    ...

    Prolonged amenorrhea can result in early bone loss and increased risk of osteoporosis. Amenorrhea occurs naturally in some women who are breast-feeding, but in these circumstances it does not put the bones at risk. Another complication of amenorrhea is infertility, which may be reversible with pituitary tumor treatment, and when not, is often amenable to assisted reproductive technologies. Low estrogen levels associated with amenorrhea can cause vaginal dryness and pain with intercourse. In women with primary amenorrhea (who do not have a first menstrual period as a teenager), sexual development can be absent or delayed without appropriate hormonal treatment prescribed by an expert in this area.


  • Preparing for your appointment
    Write down questions to ask your doctor.

    You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to an endocrinologist, a doctor who specializes in endocrine (hormonal) disorders.

    Special Instructions (If available, please bring):

    • Copies of your medical records/discharge summary/physician notes.
    • A copy of your MRI or CT on a CD.
    • A copy of your lab reports.
    • Bring any medications you are taking with you to your appointment.
    • Please make sure your MGH registration is accurate and up-to-date.

    Our clinic assistants will help you update your hospital registration and insurance information.

    Thank you.


  • How is amenorrhea diagnosed?
    ...

    By definition, amenorrhea is diagnosed as lack of menstrual periods. Typically, in women of reproductive age, pregnancy is ruled out, as are other causes of amenorrhea, many of which are of pituitary origin. Anorexia nervosa, overexercise, stress, medications and other potential causes should be explored as appropriate. Relevant hormone testing can include an HCG (to rule out pregnancy), prolactin level, estradiol, and FSH (to rule out menopause). When signs and symptoms are suggestive of pituitary tumor syndromes as a cause, evaluation for with additional hormone testing and pituitary MRIs may be indicated.


  • How is amenorrhea treated?
    ...

    Amenorrhea is a symptom, not a disease, and the treatment depends upon the underlying cause. When a pituitary tumor is the cause of amenorrhea, treatment of the tumor often, but not always, treats the amenorrhea. For example, is the cause of amenorrhea is elevated prolactin levels from a pituitary tumor, treatment withi a medication that lowers the prolactin level will often lead to resumption of menstrual periods. When a large non-functioning pituitary tumor is causing amenorrhea by compressing the normal pituitary gland, resection of the tumor leads to restoration of normal pituitary function in about 50% of cases. Because the ovaries are not harmed by pituitary tumors, if amenorrhea continues after pituitary tumor treatment, infertility is often amenable to assisted reproductive technologies. Low bone density usual improves with resumption of menstrual periods. When it does not increase adequately, there are many treatments for osteoporosis available.


  • What research is being done on amenorrhea?
    ...

    The MGH Neuroendocrine Unit has an active research program aimed at understanding the causes and complications, including bone loss, of amenorrhea, particularly in women with anorexia nervosa and amenorrhea due to excessive exercise.



Disclaimer About Medical Information: The information and reference materials contained herein is intended solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. All visitors to this and associated sites from the Neurosurgical Service at MGH agree to read and abide by the the complete terms of legal agreement found at the Neurosurgery "disclaimer & legal agreements."

Physicians' Pituitary Information Service - Physicians with questions may contact Dr Biller or Dr Klibanski at 617.726.3965 or 1.888.429.6863 or via e-mail at - pituitary.info@partners.org :: Research Studies

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