AMENORRHEA (Part Three)

Risk Factors

1. Family history
2. Eating disorders (anorexia, bulimia...)
3. Increased physical activity (athletes)
4. Various contraceptive medications and those used for the treatment of chronic diseases

Clinical Signs

1. Absence of menstruation for more than 90 days
2. Pelvic pain
3. Signs of increased androgen activity (acne, hirsutism, obesity, headaches, hair loss...)

Diagnosis

1. Careful personal and family history
2. General and gynecological examination (bimanual vaginal examination)
3. Abdominal and transvaginal ultrasound examinations (assess structural problems)
4. Laboratory tests, assessing the overall and hormonal status of the body (prolactin, thyroid function tests, pregnancy test, FSH, LH, and androgens)
5. Imaging examinations (CT, MRI)

Differential Diagnosis

1. Anorexia nervosa
2. Anxiety disorders
3. Depression
4. Prolactinoma
5. Congenital adrenal hyperplasia
6. Iatrogenic Cushing's syndrome
7. Follicle-stimulating hormone anomalies
8. Luteinizing hormone deficits
9. Ovarian insufficiency
10. Pregnancy

Complications

1. Infertility
   Leads to a decline in fertility, premature ovarian insufficiency, and even irreversible infertility.
2. Osteoporosis
   Prolonged amenorrhea leads to a decrease in circulating estrogen levels, responsible for decreased bone density, osteoporosis, and even bone fractures.
   Women with polycystic ovary syndrome have a higher risk of diabetes and cardiovascular problems.

Treatment

Treatment will be based on the respective cause, involving medication, hormonal, and surgical treatment.

Treatment begins with:

• Initial counseling regarding stress and other risk factors.
• Hormone replacement therapy
• Vitamin D (1000 IU per day) and calcium (1200-1500 mg per day)
• Regular physical activity for 20-30 minutes per day