Normal menstruation is the end product of a complex interplay of health and hormones. It is more amazing that “normal” menstruation occurs regularly and that cyclic changes are often predictable and expected. Women, unless frequently pregnant or amenorrheic, spend up to one sixth of their lives actually menstruating. Variations in time and amount of bleeding, unpredictability, excessive bleeding, pain, cramps, bloating, and weight gain are not mere annoyances, but symptoms of irregularities that must be addressed and the symptoms improved if at all possible. Amenorrhea: Amenorrhea is the absence of normal menstrual periods for six months. Primary amenorrhea means never having a menstrual period. Secondary amenorrhea means an absence of menstrual periods after the initiation of normal menstrual periods. Amenorrhea occurs in approximately 1.8 to 5% of women and in 38-42% of adolescents. Amenorrhea is seen in approximately 50% of competitive runners, 25% of recreational runners, and 44% of professional dancers. Amenorrhea, especially with galactorrhea, can have serious health consequences. It can be associated with bone loss and fractures, infertility, dyspareunia, and if causing endometrial hyperplasia, endometrial cancer. Etiology of irregular menstruation (Table 10.1) Many of the causes of amenorrhea can also cause oligomenorrhea, metrorrhagia, menorrhagia, and other irregularies of menstruation. The following are some causes of menstrual changes. Physiological causes: A. The most common cause of primary and secondary amenorrhea is pregnancy. B. Postpartum amenorrhea can last up to 12 months, but usually is less than three months. C. During lactation, amenorrhea often occurs for six to nine months depending on the amount of breastfeeding and amount of supplementation to the child (Table 10.2). The longer a woman breast feeds, the longer her period of amenorrhea post-lactation will most likely be (Figure 10.1).
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