Overview of the Research
Kate B. Daigle in The Clinical Guide to Fertility, Motherhood, and Eating Disorders, 2019
Many of the physical complications of anorexia are due to effects of starvation. In a woman, a major marker of this disease is amenorrhea, or the loss of her period. Primary amenorrhea occurs when a woman age 15 or older never has had her period, and secondary amenorrhea occurs in a woman who has had regular periods but loses her period for a time span of 3 months or more. The loss of menstruation prohibits egg production and shuts down the reproductive system. Hypothalamic amenorrhea, a component of secondary amenorrhea, is common in people with anorexia and occurs when the hypothalamus, which is in the center of the brain and controls reproduction, stops producing gonadotropin-releasing hormone (GnRH). This is the hormone that starts the menstrual cycle, and it can stop it if it does not sense sustainability. One of the factors of this is low body weight, which may or may not be connected to an eating disorder.3
The reproductive system
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Amenorrhea is said to occur when a woman misses three successive menstrual cycles. This can occur naturally if a woman is pregnant, breastfeeding or entering menopause. It may also be caused by the use of oral contraceptives or other medications such as antidepressants, antipsychotics, antihypertensives and chemotherapy agents. Heavy exercise or physical exertion and marked reductions in body fat can also cause amenorrhea. All of the above would be classified as secondary causes of amenorrhea. Primary causes of amenorrhea would include abnormalities of the hypothalamus or pituitary gland or genetic abnormalities such as Turner syndrome. Diagnosis is generally made through measurement of circulating hormones and imaging studies to rule out other causes. Treatment will depend upon the cause of the amenorrhea and may involve hormonal therapy.
Amenorrhea and hirsutism
Philip E. Harris, Pierre-Marc G. Bouloux in Endocrinology in Clinical Practice, 2014
Amenorrhea is conventionally defined as absence of periods for 6 months or more. Amenorrhea can be further categorized as primary amenorrhea in a woman who has never menstruated and secondary amenorrhea in a woman who has had at least one period. With the exception of a small proportion of cases in which there is a congenital or acquired genital tract abnormality, amenorrhea is indicative of anovulation and most commonly reflects a disorder of gonadotropin regulation or PCOS. As one might expect, the proportion of young women who have a congenital abnormality of ovarian development (such as Turner syndrome) or of the genital tract is greater in women with primary amenorrhea than in women with secondary amenorrhea (such congenital abnormalities accounting for about 60% of cases of primary amenorrhea); otherwise, there is considerable overlap in causes of primary and secondary amenorrhea.1 In adolescent girls, there is little distinction between delayed menarche (defined as no periods by 16 years of age) and primary amenorrhea, but it is important to assess the stage of pubertal development in girls with delayed menarche. The causes of secondary amenorrhea are summarized in Table 18.2.
Demographic, clinical and hormonal characteristics of patients with premature ovarian insufficiency and those of early menopause: data from two tertiary premature ovarian insufficiency centers in Greece
Published in Gynecological Endocrinology, 2020
Maria Sotiria Bompoula, Georgios Valsamakis, Spyridoula Neofytou, Pantelis Messaropoulos, Nikolaos Salakos, George Mastorakos, Sophia N. Kalantaridou
Archived information of 139 women of Greek origin (age range: 14- to 45-year old) followed in the departments of menopause of Aretaieion and Attikon Hospital between 2015 and 2019 were retrospectively retrieved by the same observer (MSB). These women consulted for menstrual disturbances (oligo/amenorrhea), subfertility or a positive family POI history. Oligomenorrhea was defined as presence of eight or less menstrual cycles during a year. Amenorrhea was defined as primary (absence of menstrual cycles till the age of 16 years) or secondary (absence of menstrual cycles for six months or longer in a previously normally cycling woman) [13]. Subfertility was defined as any form of reduced fertility with prolonged time of unwanted non-conception [14]. Diagnosis of POI was based on ESHRE definition (women <40-year old; oligo/amenorrhea for at least 4 months and elevated FSH levels > 25 IU/L on two occasions >4 weeks apart) [9]. Early menopause was diagnosed in women, who presented the aforementioned symptoms at the age between 40 and 45. In our study, we excluded patients with iatrogenic POI (after chemotherapy, radiotherapy, gynecological surgery). All patients were informed about the study and gave their consent.
POI after chemotherapy and bone marrow transplant may mimic disorders of sexual differentiation – a case report of a patient with primary amenorrhea and 46, XY karyotype
Published in Gynecological Endocrinology, 2020
Jagoda Kruszewska, Sandra Krzywdzińska, Monika Grymowicz, Roman Smolarczyk, Blazej Meczekalski
Primary amenorrhea is, according to the most recent consensus, a condition defined as an absence of menarche stated at the age of 15 or three years after thelarche [1]. It may appear as a sign of various disorders including impairment of the ovaries, the hypothalamus or pituitary gland, anatomical abnormalities within the genitourinary tract and metabolic or endocrinologic disorders [2]. Therefore differential diagnostic should consist of establishing past medical history, performing a gynecological examination, marking full hormonal profile and determining the patient’s karyotype. The recent may be the decisive measure in some chromosomal abnormalities, allowing to exclude Turner Syndrome (46, XO) and other disorders of sexual differentiations. 46, XY karyotype is not a common result in phenotypically female patients presented with primary amenorrhea [3,4]. In female individuals with 46, XY genotype prophylactic gonadectomy is required because of the high prevalence of gonadal tumors [5]. Oncological treatment during childhood may also lead to primary amenorrhea due to gonadotoxic effect of chemotherapy and irradiation.
The Relationship Between Female Reproductive Functions and Vitamin D
Published in Journal of the American College of Nutrition, 2018
Sabriye Arslan, Yasemin Akdevelioğlu
Primary amenorrhea is defined as the failure to reach menarche. Primary amenorrhea is often, but not exclusively, the result of chromosomal irregularities that lead to premature ovarian insufficiency or anatomic abnormalities. Premature ovarian insufficiency, which refers to the onset of menopause before age 40, may also be influenced by vitamin D levels. Other than the age factor, AMH is a good indicator of this syndrome (14). In a study on serum vitamin D steroid hormones, sex hormone binding globulin (SHBG) and ovarian reserve markers in 73 nonobese healthy females revealed a positive relationship between vitamin D level and total testosterone and free androgen index. It has been argued that vitamin D may increase fertility by modulating androgenic activity (15). It is believed that low vitamin D levels may affect ovarian reserve and induce premature menopause in predisposed females. Further, patients with premature ovarian insufficiency should take supplemental calcium and vitamin D for optimal bone health.
Related Knowledge Centers
- Egg Cell
- Lactation
- Menarche
- Menstrual Cycle
- Oligomenorrhea
- Ovary
- Menopause
- Pregnancy
- Breastfeeding
- Secondary Sex Characteristic