Secondary amenorrhoea is commoner so it will be discussed first and in more detail.
There are two areas of the brain which influence the menstrual cycle – the hypothalamus and the pituitary. The hypothalamus produces gonadotrophin releasing hormone (GnRH) which stimulates the anterior pituitary to produce luteinising hormone (LH) and follicle stimulating hormone (FSH). The anterior pituitary hormones then affect the ovaries causing release of oestradiol, progesterone and inhibin. These hormones have a intricate link and the timings and amounts affect the menstrual cycle.
The diagram below illustrates the influence of the brain and ovaries on the production of hormones.
Again, the causes can be split into the
Commonly it can be constitutional,
often following a family pattern, which
is the commonest cause. However, it
can also be due to the effect of other
chronic illnesses such as diabetes.
Anorexia nervosa or excessive
exercise can be a cause in teenagers.
Problems with the development of the
pituitary or tumours of the pituitary or
hydrocephalus are much rarer causes.
Problems with the normal functioning
of the ovaries or the absence of ovaries
can also result in no menses. This can
be due to abnormal development,
premature ovarian failure, genetic
problems, autoimmune disease,
infections or following chemotherapy/
Genetic problems can be a rare cause
of amenorrhoea e.g. Turner syndrome
which is when the child only has one
copy of the X chromosome.
Anatomical causes are more common
in primary amenorrhoea:
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