The Long-Term Cardiovascular Risks Associated with Amenorrhea
Gonadal steroids are important for healthy functioning of the reproductive tract, but also for general women’s health issues such as maintenance of bone mass, the cardiovascular system, cognition, wellbeing, and sexuality. Hypoestrogenism can interfere wi
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Tommaso Simoncini, Andrea Giannini, and Andrea R. Genazzani
Amenorrhea is the absence or abnormal cessation of the menses. Primary and secondary amenorrhea describe the occurrence of amenorrhea before and after menarche, respectively. The majority of the causes of primary and secondary amenorrhea are similar. Timing of the evaluation of primary amenorrhea recognizes the trend to earlier age at menarche and is therefore indicated when there has been a failure to menstruate by age 15 in the presence of normal secondary sexual development (two standard deviations above the mean of 13 years), or within 5 years after breast development if that occurs before age 10. Failure to initiate breast development by age 13 (two standard deviations above the mean of 10 years) also requires investigation. In women with regular menstrual cycles, a delay of menses for as little as 1 week may require the exclusion of pregnancy; secondary amenorrhea lasting 3 months and oligomenorrhea involving less than nine cycles a year require investigation. The prevalence of amenorrhea not due to pregnancy, lactation, or menopause is approximately 3–4 %. Although the list of potential causes of amenorrhea is long, the majority of cases are accounted for by four conditions: polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, and ovarian failure. Secondary amenorrhea, which is defined as 3 months absence of menstruation, occurs in approximately 3–5 % of adult women [1, 2]. According to the American Society of Reproductive Medicine, Functional Hypothalamic Amenorrhea (FHA) is one of the most common causes of secondary amenorrhea; therefore, it is responsible for 20–35 % of secondary amenorrhea cases and approximately 3 % of cases of primary amenorrhea. There are three types of FHA: weight loss-related, stress-related, and exercise-related amenorrhea therefore, DeSouza et al. estimated that approximately 50 % of women who exercise regularly T. Simoncini, MD, PhD (*) • A. Giannini • A. Genazzani Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Via Roma, 67, 56100 Pisa, Italy e-mail: [email protected] © International Society of Gynecological Endocrinology 2017 C. Sultan, A.R. Genazzani (eds.), Frontiers in Gynecological Endocrinology, ISGE Series, DOI 10.1007/978-3-319-41433-1_10
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experience subtle menstrual disorders and approximately 30 % of women have amenorrhea, for that reason the incidence of FHA is higher in athlete women. The complex of distorted eating, amenorrhea, and osteoporosis was first described in 1997 and is known as female athlete triad. FHA results from the aberrations in pulsatile gonadotropin-releasing hormone (GnRH) secretion, which in turn causes impairment of the gonadotropins (follicle-stimulating hormone and luteinizing hormone). The final consequences of these clinical conditions are complex hormonal changes manifested by profound hypoestrogenism leading to several short and long-term health implicat
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