Amenorrhea is the absence of the menstrual cycle with a reduced number of cycles in the woman. Amenorrheic is defined as a woman who has a menstrual cycle every 90 days. A distinction is made between primary amenorrhea and secondary amenorrhea:
- Primary amenorrhea: when the woman has never had menarche, i.e. the first menstrual flow;
- Secondary amenorrhea: if the woman has already had her first menstrual flow, but menstruation has been absent for at least 3 months in women with regular menstrual cycles or for ≥ 6 months in women with irregular menstrual cycles.
This distinction is important because in primary amenorrhea it is necessary to identify whether the person has an integrity of the internal and external genital apparatus, since the presence of menstruation guarantees the presence of the ovaries, normal hormonal production and function, the uterus and a patent vagina. In the case of primary amenorrhea, a genetic study is also carried out since a part of the primary amenorrhea is linked to deficits of this kind.
There are three etiopathogenetic groups of amenorrhea:
- Failure to produce oocytes and hormones (estrogen-progestin): amenorrhea is the result of primary ovarian failure (e.g., due to genetic diseases) or secondary ovarian failure due to early termination before the age of 40.
- From hypothalamic-pituitary dysfunction with impact on ovarian function. These problems can also be caused by stress and significant weight loss. For example, anorexia and competitive sports could also act by causing a drastic reduction in adipose tissue responsible for estrogen metabolism.
- From anatomical alterations: amenorrhea can be due to malformations of the genital apparatus with absent ovaries or absent or rudimentary uterus. A form of anatomical anomaly amenorrhea is Rokitanski-Mayer-Kuster-Hauser syndrome characterized by vaginal deficiency and marked uterine hypoplasia. There may also be problems with the transit of the menstrual flow in the case of hymenal perforation, whereby the hymenal membrane blocks the passage of the menstrual flow.
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