Amenorrhoea

 Amenorrhea is the absence of menses - it may be primary or secondary

Primary Amenorrhoea:

Primary amenorrhoea occurs when a girl hasn't started menstruating by the age of 16.

Causes:
   - Genetic disorders like Turner syndrome where one X chromosome is missing or 

Mayer-Rokitansky-Küster-Hauser syndrome) ( absent uterus) 
   - Hormonal imbalances (e.g., hypogonadotropic hypogonadism where stimulating hormones are deficient
   - Anatomical abnormalities (e.g., imperforate hymen, vaginal agenesis)
   - Chronic illnesses (e.g., thyroid disorders, diabetes, tuberculosis)

Secondary Amenorrhoea:

Secondary amenorrhoea occurs when a woman who previously menstruated stops getting periods for three months or more.

Causes:

Chronic disease like anaemia or tuberculosis 

Deficiency of Vitamin D and Calcium which is needed for ovulation

Hormonal imbalances (e.g., polycystic ovary syndrome (PCOS), thyroid disorders, excess Prolactin hormone
Pregnancy or breastfeeding
Weight changes or extreme exercise both severe weight gain or weight loss. Athlete’s amenorrhea sometimes occurs in women training for marathons etc when Prolactin production increases
Stress or emotional trauma
Certain medications (e.g., Proton pump inhibitors like Pantoprazole, omeprazole etc, antidepressants, antipsychotics)
Underlying medical conditions (e.g., premature ovarian failure, pituitary gland problems)

Symptoms associated

Absence of menstrual period

Pallor iron or B12 deficiency anaemia is read by the body as a bad time to have a baby. Nature take care by stopping ovulation causing amenorrhea 

Hormonal imbalances:
   - Mood swings
   - Weight gain or loss
   - Hair loss or excessive hair growth
   - Acne
Infertility:
   - Difficulty getting pregnant
   - Irregular ovulation
Other symptoms may vary depending on the underlying cause:
   - Hot flashes (menopausal symptoms)
   - Galactorrhea (milk production not associated with childbirth or nursing)
   - Headaches or vision problems (pituitary gland issues)

Symptoms of underlying disease like tuberculosis- cough, weight loss,  appetite loss

Treatment Options:

1 Medication to treat underlying condition like   Correction of anaemia, thyroid disorder, prolactin excess, diabetes or raised insulin, vitamin D and calcium deficiency 

   - Birth control pills or patches to regulate menstrual cycles
   - Hormone replacement therapy (HRT) for menopausal symptoms
   - Medications to stimulate ovulation in cases of infertility 

2. Lifestyle changes:
   - Maintaining a healthy weight through diet and exercise
   - Reducing stress through relaxation techniques (e.g., yoga, meditation)
   - Getting enough sleep and practicing good sleep hygiene

3 Surgery:
   - Surgery to correct anatomical abnormalities (e.g., hymenectomy for imperforate hymen)
   - Surgery to remove tumors or cysts that may be causing hormonal imbalances
    - Surgery to remove intra uterine scarring and allow growing back of the inner lining

Conclusion:
Amenorrhoea can be a complex condition, but with proper diagnosis and treatment, many women can experience regular menstrual cycles and improved overall health. It's essential to consult a healthcare provider for personalized guidance and care.