The Absence of Menstrual Flow - Case Study Example

Amenorrhea Lecturer Introduction Menorrhea refers to the absence of menstrual flow, categorized into two types, secondary and primary amenorrhea. Primary amenorrhea will occur to a girl who has not begun their menstrual cycle by the age of 16 years. At this age it is advisable that a healthcare provider should evaluate any girl who has not shown signs of sexual development such as breast development. However, secondary amenorrhea will occur to a woman who had regular periods, and they stop for more than three months. Secondary amenorrhea has been associated with symptoms such as having irregular cycles and dysmenorrhea (Klein & Poth, 2013). This paper will discuss a case study that involves a 30-year-old female whose has secondary amenorrhea for six months. Prior to being diagnosed with the disorder, she presented with periods of irregular cycles and dysmenorrhea. Thus, the paper will discuss the pathophysiology of the disorder and it possible causes in relation to irregular cycles and dysmenorrhea. Amenorrhea is a menstrual disorder that refers to the absence of menstruation in a woman who had been previously having their normal menstrual cycle. Secondary is used to refer to menstruation that had previously occurred at least for some period but stopped for a period of six months or longer due to some reasons. In order for the woman to be diagnosed with secondary amenorrhea, they must miss their menstrual period for a period of at least three to six months without being pregnant (Heiman, 2009). The most significant contributing factors include the use of birth control pills, certain medications and stress that also have been associated to cause dysmenorrhea (painful cramping) and irregular cycles. The most common reason as to why a woman will miss their period is as a result of pregnancy. However, it should be noted that pregnancy, menopause and breastfeeding are not classified as causes of the disorder. Secondary amenorrhea is not harmful to the patients’ health as it can be treated effectively in the majority of the cases according to the pathophysiology. Thus, it is important for the health care practitioner to address the underlying condition causing the menstrual disorder to ensure that optimal health of the woman is regained (Klein & Poth, 2013). Pathophysiology of secondary amenorrhea The hypothalamus is involved in generating the gonadotropin-releasing hormones that are responsible for stimulating the pituitary gland to produce the gonadotropins i.e. the Luteinizing Hormone and Follicle- stimulating hormone into the blood stream. These gonadotropins are important in stimulating the ovaries to produce estrogen, progesterone and other androgens that have various functions. The follicle-stimulating hormone is responsible for stimulation of conversion of testosterone to estrogen. Estrogen is then involved in stimulating the endometrium to cause proliferation (Gordon, 2010). The LH is responsible for promoting the maturation of the oocyte and development of corpus letuem that is responsible for progesterone production. Progesterone is then responsible for changing the endometrium into a secretory structure preparing it for egg implantation. If the pregnancy does not take place, the progesterone and estrogen levels production is bound to decline. The endometrium breaks down and will be sloughed during menses. In a normal cycle, menstruation occurs after 14 days after ovulation. When any part involved in the system dysfunctions, then ovulatory disorder is bound to occur leading to the disruption of the cycle of estrogen production as well the cycle endometrial changes is disrupted. The menstrual flow will not occur resulting in secondary amenorrhea. Thus, secondary amenorrhea is anovulatory. However, the disorder can occur when the ovulation is normal as in the cases of genital abnormalities such as intrauterine adhesions and congenital abnormalities that will cause outflow obstruction. These conditions have also been associated to cause painful menses (Dysmenorrhea) and irregular periods, as well as the prevention of menstrual flow, despite body’s normal hormonal stimulation (Master-Hunter & Heiman, 2006). Causes The estrogen level increases and is responsible for causing the lining of the uterus to grow and thicken in a normal cycle. Estrogen hormone is responsible for sex characteristics development and maintaining the reproductive process in women. If the egg is not fertilized, the hormone levels fall as shedding of the uterine lining results. However, several factors can disrupt the process. The most common cause of secondary amenorrhea is hormonal imbalances that occur due to the presence of tumors in the pituitary gland, too much testosterone production in the body, an overactive thyroid gland as well as in cases of low estrogen levels. (Achrekar, Modi, Meherji, Patel, & Mahale, 2010) Testosterone, a male sex hormone, plays a major role in the growth and development of reproductive tissues in the female gender. If these levels are, too high, they result in irregular cycles and absent menstrual period, thus irregular cycles is a symptom bound to result in cases of secondary amenorrhea. Hormonal birth control pills commonly used for family planning methods can also lead to the occurrence of secondary amenorrhea (Klein & Poth, 2013). Depending on the differences in women, tea pills, and the Depo-Provera shots, may cause irregular periods, painful periods and even missed periods. Structural issues i.e. polycystic ovarian disease syndrome can lead to hormonal imbalances resulting in weight gain and unwanted hair growth among some women. The growth of cysts on the ovaries results in hormonal imbalances and can result in irregular cycles or amenorrhea. Scar tissue formation resulting from pelvic infections, as well as multiple dilation and curettage procedures, can result in painful menses and as well prevent menstruation. Dilation and curettage are a surgical procedure used to remove excessive tissue growth from the uterus and for the treating of abnormal uterine bleeding (Hirvonen, 1977). Thyroid diseases, ovarian failure, increased stress levels, eating disorder have been associated with causes of secondary amenorrhea and also risk factors of dysmenorrhea and irregular menstrual cycles. The occurrence of polycystic ovarian disease has been associated to present with amenorrhea (Klein & Poth, 2013). Lifestyle factors are also a contributing factor to secondary amenorrhea occurrence. Body weight plays an essential role in ensuring the occurrence of regular menstruation. Women who are obese and overweight or are underweight with less than 15 percent of body fat are prone to secondary amenorrhea (Selzer, Caust, Hibbert, Bowes, & Patton, 1996). This can be illustrated for athletes who get secondary amenorrhea due excessive training. As illustrated earlier emotional stress factors is a cause of secondary amenorrhea. The body responds to the stress levels by temporary delaying the menstrual cycle leading to irregular cycles or secondary amenorrhea burn once the anxiety and tension are resolved the period’s resumes (Heiman, 2009). Conclusion The management of secondary amenorrhea entails restoration of the ovulatory cycle by estrogen replacement, management of the associated disorders, reassurance to alleviate associated anxiety and reevaluation. Surgery is also used for the treatment of the underlying pathological disorders. Thus, it is important for the healthcare provider to determine the pathophysiology and cause of secondary amenorrhea to be able to manage the condition effectively. Irregular cycles and painful periods are major symptoms that are associated with secondary amenorrhea, therefore, effective management is essential. References Achrekar, S. K., Modi, D. N., Meherji, P. K., Patel, Z. M., & Mahale, S. D. (2010). Follicle stimulating hormone receptor gene variants in women with primary and secondary amenorrhea. Journal of Assisted Reproduction and Genetics, 27, 317–326. doi:10.1007/s10815-010-9404-9 Gordon, C. M. (2010). Clinical practice. Functional hypothalamic amenorrhea. The New England Journal of Medicine, 363, 365–371. doi:10.1056/NEJMcp0912024 Heiman, D. L. (2009). Amenorrhea. Primary Care, 36, 1–17, vii. doi:10.1016/j.pop.2008.10.005 Hirvonen, E. (1977). Etiology, clinical features and prognosis in secondary amenorrhea. International Journal of Fertility, 22, 69–76. Klein, D. A., & Poth, M. A. (2013). Amenorrhea: An approach to diagnosis and management. American Family Physician, 87, 781–788. Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician. Selzer, R., Caust, J., Hibbert, M., Bowes, G., & Patton, G. (1996). The association between secondary amenorrhea and common eating disordered weight control practices in an adolescent population. Journal of Adolescent Health, 19, 56–61. doi:10.1016/1054-139X(95)00229-L Read More