Ipsita Mishra1, Arun Kumar Choudhury2, Debasish Patro3, Anoj Kumar Baliarsinha4
Amenorrhea refers to the absence of menstrual periods and may result from a number of different conditions. The normal menstrual cycle involves complex interactions between the hypothalamic pituitary axis, the ovaries and the outflow tract, thus disruption at any level can result in abnormal menstruation and amenorrhea. Amenorrhea is broadly classified into primary or secondary. Amenorrhea is classified as primary if menstrual bleeding has never occurred in the absence of hormonal treatment. The clinical significance of lack of regular menstrual cycles extends beyond reproductive concerns and include implications on bone and cardiovascular health.
The aim of this study was to evaluate the clinical profile and etiology, mean age of presentation of common etiologies, common age group of presentation, variation of gonadotropin levels, of patients of primary amenorrhea presenting to Endocrine OPD of a tertiary care hospital.
MATERIALS AND METHODS
We assessed the records of patients who were evaluated for primary amenorrhea by age 16 years in the presence of normal growth and secondary sexual characteristics and patients who were evaluated for absence of secondary sexual characteristics by age 13 with or without short stature, between May 2014 to June 2017 in our Endocrine department. The patients were subjected to a detail history, thorough clinical examination, relevant biochemical, hormonal and radiological investigations as indicated.
Design- Cross-sectional study.
In our study, a total number of 29 patients presented for evaluation during the study period. The mean age of presentation of patients with primary amenorrhea was 20.21±4.08 years. 65% (N=19) of patients presented between 11-20 years and 35% (N=10) presented between 21-30 years. The most common causes of primary amenorrhea were Turner syndrome (45%; N=12) and Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH) (10%, N=3). Among patients with Turner syndrome most common cause for seeking medical evaluation was both primary amenorrhea and short stature rather than short stature alone.
In concordance with other studies, Turner syndrome and Mullerian agenesis disorders are the commonest causes of primary amenorrhea in our study. Prolonged untreated hypothyroidism though identified as an important cause of secondary amenorrhea can also present as primary amenorrhea in few cases. Treatment should begin immediately after diagnosis in a patient tailored fashion not only to facilitate normal secondary sexual features and fertility concerns but also to preserve bone and cardiovascular health.