Amenorrhea

Amenorrhea can result from abnormalities in the brain, pituitary gland, thyroid gland, adrenal glands, ovaries (ovarian) as well as other parts of the reproductive system.

Under normal circumstances, the hypothalamus (part of the brain located above the pituitary gland) sends a signal to the pituitary gland to release hormones that stimulate the release of an egg by the ovaries.
Disease In particular, the formation of abnormal pituitary hormones can lead to inhibition of release of eggs and the disruption of a series of hormonal processes involved in the occurrence of menstruation.

Causes of primary amenorrhea:
The delay in menarche (first menstruation)
Congenital abnormalities of the genital system (eg do not have a uterus or vagina, the presence of septum in the vagina, cervix is ​​the narrow, holes in the membrane covering the vagina is too narrow / imperforate hymen)
Drastic weight loss (due to poverty, excessive dieting, anorexia nervosa, bulimia, etc.)
Congenital abnormalities of the genital system
Chromosomal abnormalities (eg, Turner syndrome or Swyer syndrome) in which cells contain only one X chromosome)
Extreme Obesity
Hypoglycemia
Gonadal dysgenesis
Hypogonadotropic hypogonadism
Testicular feminization syndrome
True hermaphrodites
Chronic disease
Malnutrition
Cushing's disease
Cystic Fibrosis
Congenital heart disease (cyanotic)
Kraniofaringioma, ovarian tumors, adrenal tumors
Hypothyroidism
Syndrome Adrenogenital
Prader-Willi syndrome
Ovarian disease polikista
Congenital adrenal hyperplasia
Causes of secondary amenorrhea:
Gestation
Anxiety about pregnancy
Drastic weight loss
Excessive Exercise
Body fat of less than 15-17% extreme
Consuming extra hormones
Obesity
Emotional stress
Menopause
Endocrine disorders (eg Cushing's syndrome, which produce large amounts of the hormone cortisol by the adrenal glands)
Drugs (such as busulfan, chlorambucil, cyclophosphamide, birth control pills, fenotiazid)
Dilatation and curettage procedure
Abnormalities of the uterus, such as hydatidiform mole (placental tumor) and Asherman's syndrome (scarring of the lining of the uterus due to infection or surgery).

SYMPTOMS
Symptoms vary, depending on the cause.

If the cause is the failure of puberty, then it will not be found the signs of puberty such as breast enlargement, growth of pubic hair and underarm hair SERT changes in body shape.

If the cause is pregnancy, morning sickness will be found and an enlarged abdomen.
If the cause is high levels of thyroid hormone symptoms are rapid heartbeat, anxiety, skin warm and moist.

Cushing's syndrome causes a round face (moon face), distended belly and skinny arms and legs.

Other symptoms that may be found on amenorrhea:
Headache
Galactorrhea (milk formation in women who are not pregnant and not breastfeeding)
Visual impairment (on pituitary tumor)
Decrease or weight gain, which means
Vaginal dryness
Hirsutism (excessive hair growth, which follows the pattern of men), voice changes and changes in breast size

Diagnosis
Diagnosis based on symptoms, physical examination results and patient age.

Regular checks carried out are:
Endometrial biopsy
Progestin withdrawal
Prolactin levels
Levels of hormones (eg testosterone)
Thyroid function tests
Pregnancy tests
Levels of FSH (follicle stimulating hormone)
Karyotype to determine chromosomal abnormalities
CT scan of the head (if it is suspected pituitary tumor).

TREATMENT
Treatment depends on the cause.
If the cause is a drastic weight loss or obesity, patients are advised to undergo proper diet.
If the cause is excessive exercise, patients are recommended to reduce them.

If a girl has never experienced menstruation and all results are normal, then the examination every 3-6 months to monitor the progression of puberty.
To stimulate menstruation may be given progesterone.
To stimulate the pubertal changes in girls who have enlarged breasts or pubic and armpit hair has not grown, can be given estrogen.

If the cause is a tumor, then surgery to remove tumors proficiency level.

Pituitary tumors are located in the brain are usually treated with bromocriptine to prevent excessive release of prolactin by these tumors.
If you need to do removal of the tumor. Radiation therapy is usually only done if the administration of drugs or surgery does not work.