Applied exercise physiology and health
Nick Draper, Helen Marshall in Exercise Physiology, 2014
There is a common misconception that the absence of regular menstrual cycles is a normal consequence of training and competing at the elite level. This, however, should not be sustained and amenorrhea, brought on by low energy availability, forms one of the points of the Triad triangle (Figure 14.1). If menstrual cycles have been absent for three or more months the condition is termed secondary amenorrhea, whereas primary amenorrhea relates to a delayed age of menarche. In the Triad, menstrual disorders result from the impaired secretion of luteinising hormone from the pituitary gland and, this type of amenorrhea is referred to as functional hypothalamic amenorrhea. The relationship between amenorrhea and sports training appears to remain unclear, although one study found ballet dancers to experience menarche at a later age, albeit at the same height and weight as in non-dancers (Warren, 1980).
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
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.
Prevalence of polycystic ovary syndrome in Thai University adolescents
Published in Gynecological Endocrinology, 2018
Jetsadaporn Kaewnin, Orawin Vallibhakara, Sakda Arj-Ong Vallibhakara, Penpun Wattanakrai, Benjamaporn Butsripoom, Ekasith Somsook, Sirichai Hongsanguansri, Areepan Sophonsritsuk
The Rotterdam criteria were used to diagnose PCOS and require that two of the following features be present: OA, HA, or polycystic ovaries [2]. Oligomenorrhea was defined as absence of menstruation for ≥45 days and/or ≤8 cycles per year. Secondary amenorrhea was defined as the absence of menstruation for >90 days after menarche [2]. Clinical HA was defined by having any of the following features: a Ferriman–Gallwey (FG) score >6 [8], moderate-to-severe acne based on the Global Acne Grading System (GAGS), or androgenic alopecia. The GAGS scores the severity of acne as none (0 points), mild (1–18 points), moderate (19–30 points), severe (31–38 points), or very severe (>38 points). Biochemical HA was defined as testosterone >63 ng/dL (2.8 nmol/L) [9]. Ovaries were considered to have polycystic ovarian morphology (PCOM) with the presence of >12 cysts measuring 2–9 mm in diameter and/or ovarian volume >10 cm3. Transabdominal pelvic ultrasonography was performed by one operator (JK) using the Voluson ®E8 Ultrasound (GE Healthcare, (Chicago, IL) with a 4- to 8-mHz convex array probe.
The influence of estro-progestin therapy on neurohormonal activity in functional hypothalamic amenorrhea
Published in Gynecological Endocrinology, 2022
Anna Szeliga, Agnieszka Podfigurna, Gregory Bala, Blazej Meczekalski
Functional hypothalamic amenorrhea (FHA) is a chronic endocrine disorder caused by a disturbance of the pulsatile secretion of hormones in the hypothalamus, which in turn results in suppression of the hypothalamic-pituitary-ovarian axis. Inhibition of pulsatile gonadotropin-releasing hormone (GnRH) secretion in the hypothalamus results in suppression of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion from the pituitary gland. This sequence leads to the suppression of the hormonal and reproductive functions of the ovary [1, 2]. Secondary amenorrhea, which is the most common symptom, is characterized as amenorrhea occurring in a previously menstruating woman. It affects approximately 3-5% of the female population in reproductive age. FHA accounts for 25% to 35% of secondary amenorrhea, making it the most common cause of secondary amenorrhea in our population. At the same time, FHA is known to be the causative agent in only about 3% of primary amenorrhea, ceding to gonadal dysgenesis and polycystic ovary syndrome as leading causes. It is estimated that up to about 17 million women worldwide suffer from FHA [3, 4].
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.
Related Knowledge Centers
- Egg Cell
- Lactation
- Menarche
- Menstrual Cycle
- Oligomenorrhea
- Ovary
- Menopause
- Pregnancy
- Breastfeeding
- Secondary Sex Characteristic