"Amenorrhoea: Understanding the Causes, Diagnosis, and Management of Absent Menstruation in Obstetrics and Gynecology" .pptx

**Amenorrhoea: Understanding the Causes, Diagnosis, and Management of Absent Menstruation in Obstetrics and Gynecology**
**Introduction**
Amenorrhoea, defined as the absence of menstruation, is a common clinical condition with significant medical implications in the field of obstetrics and gynecology. It is not a disease in itself but a symptom of underlying health issues affecting the female reproductive system, endocrine function, or overall physiological status. Amenorrhoea can be broadly classified into two main types: primary and secondary. Primary amenorrhoea refers to the failure to achieve menarche by the age of 15, while secondary amenorrhoea is the absence of menstruation for three or more consecutive cycles in a woman who has previously had regular periods.

The importance of amenorrhoea in clinical practice lies in its role as a marker of various reproductive, hormonal, and systemic disorders. It often signals underlying health concerns such as hypothalamic dysfunction, polycystic ovary syndrome (PCOS), pituitary adenomas, premature ovarian insufficiency (POI), or even more systemic conditions like thyroid disorders and eating disorders. Understanding the causes, diagnosis, and management of amenorrhoea is crucial for healthcare professionals in obstetrics and gynecology to ensure timely intervention, proper treatment, and the preservation of fertility where possible.

This review provides an in-depth exploration of amenorrhoea, focusing on its etiological factors, diagnostic pathways, and the latest medical approaches to management. By integrating evidence-based research with clinical guidelines, this review aims to enhance the understanding of amenorrhoea’s medical importance within the broader context of women’s health.

*1. Classifications and Definitions**

**1.1. Primary Amenorrhoea**

Primary amenorrhoea refers to the absence of menarche by the age of 15 in girls who show signs of secondary sexual development (such as breast growth and pubic hair) or the absence of menstruation by age 13 in those without any secondary sexual characteristics. Primary amenorrhoea is often associated with congenital anomalies, genetic disorders, or hormonal imbalances that disrupt the normal development of the reproductive system.

The primary causes of primary amenorrhoea include:
- **Gonadal Dysgenesis** (e.g., Turner syndrome)
- **Müllerian Agenesis** (also known as Mayer-Rokitansky-Küster-Hauser syndrome)
- **Constitutional Delay of Puberty**
- **Hypogonadotropic Hypogonadism** (such as Kallmann syndrome)

Secondary Amenorrhoea**
Secondary amenorrhoea is defined as the cessation of menstrual periods for three consecutive cycles or more in women who have previously had regular menstrual periods. It can occur at any reproductive age and may result from various gynecological, endocrine, or systemic factors. While pregnancy is the most common cause, other etiologies include hormonal disturbances, chronic medical conditions

1.   INTERDEPARTMENTAL INTEGRATION  OBG & REPERTORY TOPIC- AMENORRHOEA By MD SANEN S BHMS 2019-BATCH AMSHMC BELGAUM

2. Amenorrhoea

3. Physiological Amenorrhoea  

4. Before puberty The pituitary gonadotropins are not adequate enough to stimulate the ovarian follicles for effective steroidogenesis → estrogen levels are not sufficient enough to cause bleeding from the endometrium.

5. During Pregnancy  Large amount of estrogens and chorionic gonadotropins secreted from the trophoblasts suppress the pituitary gonadotropins no maturation of the ovarian follicles.

6. During Lactation  High level of prolactin → inhibits ovarian response to follicle-stimulating hormone (FSH)→ no follicular growth →hypoestrogenic state → no menstruation.

7. During Menopause  No more responsive follicles are available in the ovaries for the gonadotropins to act. As a result, there is cessation of estrogen production from the ovaries with elevation of pituitary gonadotropins.

8. Pathological Amenorrhoea  

9. Cryptomenorrhoea   Defination - 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. Causes- 1) Congenital                 2)Acquired

10. Congenital  

11. Acquired

12. Clinical features  The patient came with complaints of- Periodic pain in lower abdomen Retention of urine On abdominal examination Uniform globular mass in hypogastrium On valvular inspection Bulging of hymen On rectal examination Fullness of vagina and uterine mass

13. Real Pathological amenorrhoea  

14. Primary Real Pathological amenorrhea   A young girl who has not yet menstruated by her 16 years of age Absence of menstrual cycle at age of 14 year without secondary sexual character Absence of menstrual cycle in 16 year of age female with secondary sexual character

15. Mullerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome)

16. ✓ Unresponsive endometrium ✓Uterine synechiae

17. Hypogastrium hypogonadism 

18. Primary ovarian failure 

19. Turner's Syndrome 

20. Pure gonadal dysgenesis

21. Secondary Real Pathological amenorrhoea      Absence of menstrual cycle for 6 months or more in a woman in whom normal menstruation bas been established.

22. Uterine factors  Tubercular endometritis Post-radiation

23. Synechiae Surgical removal of endometrium

24. Uterine factors Polycystic ovarian syndrome 

25. Premature ovarian failure 

26. Hypothalamic Factors  Weight related Anorexia nervosa

27. Obesity Kallmann's syndrome

28. Pituitary factors  Adenoma Sheehan's syndrome

29. Adrenal factors  Adrenal Tumor or Hyperplasia  Cushing's syndrome

30. Thank you!