I am going to discuss about a very important topic related to Female Reproductive Health; that is Amenorrhoea. I will discuss this topic in various parts as because it’s a vast topic and in one article it’s can’t be complete. So what is Amenorrhoea?
Definition:- Amenorrhoea literally means the absence of a menstrual period in a woman of reproductive age. It’s a symptom and not a disease.
There are at least five basic factors involved in the onset and continuation of normal menstruation.
These are :- (1) Normal female chromosomal pattern(46xx)(2)Co-ordinated hypothalamo – pituitary ovarian axis.
(3)Anatomical presence and potency of the outflow tract.
(4)Responsive endometrium.
(5)Active support of thyroid and adrenal glands.
Clinical types :- (A) Physiological (B) Pathological.
Physiological :- (1) Primary Amenorrhoea (Before puberty)
(2) Secondary Amenorrhoea
(a) During Pregnancy (b) During lactation (c)Following menopause.
Pathological :- (A) Concealed(cryptomenorrhoea):- (1) Congenital (2) Acquired.
(B) Real(true):-(1) Primary (2) secondary.
Physiological:- (1) Before puberty:- The pituitary gonadotrophins are not adequate enough to stimulate the ovarian follicles for effective steroidogenesis:- oestrogen levels are not sufficient enough to cause bledding from endometrium.
(2) During pregnancy :- Large amount of oestrogens and chorionic gonadotrophins secreted from the trophoblast suppress the pituitary gonadotrophins- no maturation of the ovarian follicles.
(3)During lactation:- High level of prolactin – inhibits ovarian response to FSH -no follicular growth -hypo oestrogenic state -no menstruation. If patient does not breast-feed her baby, the menstruation returns by 6th week following delivery in about 40 % and 12th week in 80% of cases. If the patient breastfeeds her baby, the menstruation may be suspended in about 70% until the baby stops.
Pathological types of Amenorrhoea; i.e; disease types.
(A) Cryptomenorrhoea:- In cryptomenorrhoea, there is periodic shedding of the endometrium and bleeding but the menstrual blood fails to come out from the genital tract due to obstruction in the passage. It is also known as hematocolpos.
So what the obstructions are; causes :- (1) Congenital (2) Acquired.
(1)Congenital :- (1)Imperforate hymen (2) Transverse vaginal septum (3) Atresia( A condition in which a body orifice or passage in the body is abnormally closed or absent) of upper-third of vagina & cervix.
(2)Acquired :- (a) Stenosis of the cervix following amputation, deep cauterisation & conisation.
(b)Secondary vaginal atresia following neglected and difficult vaginal delivery.
Clinical features :- (1)Amenorrhea dated back from the events
(2)Periodic pain lower abdomen.
Pelvic examination reveals the offending lesion either in the vagina or cervix. The uterus is symmetrically enlarged.
Management :-(1)Cruciate incision of the hymen & drainage of blood
(2)Dilatation of the cervix in stenosis
