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     Amenorrhea affects women in a small proportion; fewer than 10% of the potential childbearing women worldwide suffer from this condition but, the incidence of this condition rises among the anorexic women and athletes.

     In spite that physical effort or intensive exercise doesn’t implicitly trigger amenorrhea, this condition occurs while the intensity of exercise is suddenly increased and also it is prevailing among gymnasts and women who practice sports usually associated with low body weight.

     We cannot speak about the typical amenorrhea symptom as this condition it’s itself a symptom; in the pathology of this condition gynecologists have to determine the related symptoms which accompany it in order to discover the problem that causes the missed periods, starting with a possible pregnancy and continuing with various abnormalities in the hormonal balance. The associated symptoms which indicate a hormonal problem are facial and body hair excess, severe acne, abnormal weight gain, false lactation, altered sex drive and lowered voice.

     If the woman experiences amenorrhea and/or any other related symptoms she must consult a gynecologist immediately.

     In order to obtain a complete diagnosis the gynecologist must collect information about woman’s family history- the age when her mother entered menopause, the date of the last period, the physiological pattern of her menstrual cycle: typical menstrual patterns – regular irregular cycles, her sex-life dynamics, contraceptive methods, pregnancy history, the amount of daily physical emotional stress and the personal way of dealing with it, if the woman suffers from other condition and the type of additional medication she uses.

     If the currant doctor is informed of the existence of amenorrhea related symptoms like acne, dry-skin, body-hair excess, abnormal breast secretions, low temperature increased intolerance or even hair loss, and if he suspects an additional hormone-related problem he will proceed to a series of tests to determine the nature of the problem. Moreover in the case of performance athlete women special attention should be paid to the daily training program, possible low fat percentage, under 22% of the body weight, or severe underweight, less than 80% of the normal body weight. An analysis of the patient’s medical history and a physical exam must follow in order to discover the underlying cause of this medical problem.

     If the physical exam doesn’t point the exact cause of amenorrhea a series of tests must follow: blood and urine tests which can determine if behind this condition there is a hormonal disorder, pituitary or thyroid gland abnormal secretions or ovaries dysfunctions. A painless test, which involves the use of sound waves to determine if there are dysfunctions inside the structure of the reproductive system, is the pelvic ultrasound test.

     Another medical test used is the progesterone challenge test: the patient is treated for a few days with progesterone hormone, if the menstrual bleeding appears it usually means that amenorrhea is caused by another problem called anovulation– condition described by the incapacity of realizing a mature egg during the menstrual cycle, however, if the bleeding doesn’t occur further tests should be made in order to determinate if the problem is situated in the ovaries or hypothalamus, the measurement of the follicle-stimulants hormones in patients blood, is required.

     However if the tests do not point out the nature of the problem, additional specialized tests are required; the diagnosis of this condition is fairly complicated because of the variety of potential cause agents.

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