Edited by Dr. Franco Recano
What is amenorrhea?
Amenorrhea is a lack of menstruation, and it must be borne in mind that there are periods in a woman's life in which this lack is physiological: before puberty, after menopause, during pregnancy and, for a more or less long period, during pregnancy. "feeding time.
An "alteration of the menstrual function (even more the lack of menstruation) is nothing more than a manifestation, a symptom we could say, of an" alteration in the succession of the phenomena that take place in the endometrium, therefore the sign that something in the regulation mechanism does not work properly. We must first make an "important distinction between" "primary" "amenorrhea (which is observed in girls or women who, despite having passed the age of puberty, have never had menstruation) and amenorrhea "" secondary "" (which instead appears after a period during which the menstrual function took place in a regular way).
Primary Amenorrhea - Causes
If the menstrual flow does not appear by the age of 16, it is called primary amenorrhea.
The fact that menstruation does not appear at the time of puberty (12-13 years) can be linked both to causes directly connected with the genital apparatus, and to causes that only indirectly affect the genital function. Among the genital causes we must remember the serious malformations of the sexual apparatus (lack or insufficient development of the ovary or of the uterus). There may then be cases in which the regulating mechanism of the ovarian and menstrual function acts regularly: these girls, all " age of puberty, have a normal body development, with the appearance of hair in the pubis, and in the armpits, development of the breasts and external genital organs, however they do not have menstruation. It is believed that in these cases there is an "insensitivity of the uterine mucosa to hormonal stimuli (estrogen and progesterone) from the ovary."
The extragenital causes are varied. They can be linked to dysfunctions of the diencephalon and pituitary, which modify or abolish the production of hypothalamic and pituitary hormones; the latter stimulate the ovary, causing the production of estrogen and progesterone. Still in the field of the endocrine system, a severe deficiency in the activity of the thyroid gland (cretinism) can be the cause of primary amenorrhea. Other factors may include severe states of malnutrition, avitaminosis, chronic infectious diseases (tuberculosis) and anemia severe.
Secondary Amenorrhea - Causes
This term indicates the cessation of the menstrual function after a period in which it took place regularly. Outside the period of pregnancy and lactation, during which the interruption of menstruation is physiological, secondary amenorrhea is the expression of a pathological state. Genital causes include those conditions which, by determining the destruction (or "removal) of one of the organs directly involved in the menstrual function, cause its definitive disappearance. They are represented by the surgical removal of the ovaries or uterus (see: hysterectomy).
Among the most important causes of secondary amenorrhea, there is that linked to the alteration of pituitary function. In these cases the stimuli caused by the pituitary hormones on the ovary cease and together with them its normal function. This pathology is accompanied by a serious decrease in the activity of all the endocrine glands that are under the control of the pituitary gland.
The phases of the menstrual cycle in the uterine mucosa depend on the action of the hormones produced by the ovary (estrogen and progesterone or, more precisely, on the quantity of each other; an imbalance between these hormones can be caused by amenorrhea. , while a significant deficiency in estrogen production prevents the "endometrium from entering the proliferative phase (which is the necessary premise for the secretory phase and menstruation to be determined), if the amount of progesterone is normal, the" action of this " the latter is not sufficient to allow the endometrium to enter the secretory phase. This leads to an arrest of the endometrium in the proliferative phase. The excessive production of progesterone determines the arrest of the cycle in the secretory phase.
Among the extragenital causes, the states of severe malnutrition can determine the interruption of the menstrual function, as well as the sudden climatic changes, nervous and psychic factors, sudden and violent emotions, daily stress and stress from sports practice in competitive athletes.
Also in the sports field, amenorrhea, associated with osteoporosis and eating disorders, is commonly included in a picture known as the "triad of the" female athlete ". This condition is common among professional athletes and, more generally, among women who practice a lot of physical activity without eating adequately.
