Introduction
False amenorrhea, also known as cryptomenorrhea, is a condition where menstruation occurs normally inside the uterus,
but menstrual blood cannot exit due to a physical obstruction in the genital tract. Unlike true amenorrhea, where
the menstrual cycle is absent due to hormonal or ovarian problems, false amenorrhea results from mechanical blockage
despite normal ovarian and hormonal function.
This condition is most commonly diagnosed in adolescent girls after puberty, when menstruation is expected to begin.
Because of its symptoms and potential complications, early recognition and treatment of false amenorrhea is crucial.
What is False Amenorrhea?
- The ovaries are functioning normally.
- The hormones (FSH, LH, estrogen, progesterone) are secreted in normal amounts.
- The uterus produces menstrual blood monthly.
- The problem: menstrual blood cannot flow out due to an obstruction in the genital tract.
In simple words: the body makes menstruation, but the blood is trapped inside because of a blockage.
Causes of False Amenorrhea (Cryptomenorrhea)
1. Congenital Causes (since birth):
- Imperforate hymen → the most common cause; hymen has no opening.
- Transverse vaginal septum → a horizontal partition inside the vagina preventing menstrual flow.
- Vaginal atresia → absence or closure of the vaginal canal.
- Cervical atresia → congenital absence or blockage of the cervical opening.
2. Acquired Causes (develop later):
- Post-surgical scarring of the cervix or vagina.
- Trauma or infections leading to adhesions.
Symptoms of False Amenorrhea
- Cyclic pelvic pain (monthly pain at the time of menses).
- Lower abdominal swelling due to retained menstrual blood (hematocolpos or hematometra).
- Urinary symptoms such as urinary retention or difficulty in urination.
- Absence of visible menstruation despite secondary sexual characteristics like breast development and pubic hair.
These symptoms usually start after puberty, when menstruation should normally appear.
Diagnosis of False Amenorrhea
Clinical Evaluation
- History: young girl with monthly pelvic pain but no menstruation.
- Examination: bulging imperforate hymen or palpable pelvic mass.
Imaging
- Ultrasound → detects accumulation of blood in the vagina or uterus.
- MRI → helpful in identifying complex cases like transverse septum or cervical atresia.
Differential Diagnosis
- True amenorrhea (hormonal causes).
- Müllerian agenesis (absent uterus).
Complications if Left Untreated
- Hematocolpos → blood trapped in the vagina.
- Hematometra → blood trapped in the uterus.
- Endometriosis → retrograde menstrual flow into the peritoneum, causing chronic pelvic pain and infertility.
- Infections due to stagnant retained blood.
- Future infertility if severe damage occurs to the uterus or fallopian tubes.
Treatment of False Amenorrhea
Treatment is always surgical, aiming to relieve the obstruction and allow normal menstruation. The exact procedure depends on the site of obstruction:
- Imperforate hymen → hymenotomy (small incision to open hymen).
- Transverse vaginal septum → surgical excision of the septum.
- Vaginal atresia → creation of a neovagina (e.g., McIndoe procedure).
- Cervical atresia → cervical dilatation or reconstructive surgery.
With early diagnosis and proper surgical correction, normal menstruation and fertility can usually be preserved.
Summary
False amenorrhea (cryptomenorrhea) is a condition where menstruation happens normally inside the uterus,
but blood cannot exit due to an obstruction like imperforate hymen or vaginal septum. It typically presents
in adolescents with cyclic pelvic pain but no periods.
Early diagnosis with ultrasound and proper surgical treatment prevents complications like endometriosis and infertility.
FAQs about False Amenorrhea
- Is false amenorrhea a hormonal problem? → No, it is a mechanical blockage.
- At what age does it appear? → Usually after puberty, when menstruation should begin.
- Can false amenorrhea cause infertility? → If untreated, yes. But after surgery, fertility is usually preserved.
- How is it diagnosed? → History, physical exam, ultrasound, or MRI.
- Is treatment complicated? → Most cases, like imperforate hymen, are treated with simple surgery (hymenotomy).
Introduction
False amenorrhea, also known as cryptomenorrhea, is a condition where menstruation occurs normally inside the uterus, but menstrual blood cannot exit due to a physical obstruction in the genital tract. Unlike true amenorrhea, where the menstrual cycle is absent due to hormonal or ovarian problems, false amenorrhea results from mechanical blockage despite normal ovarian and hormonal function.
This condition is most commonly diagnosed in adolescent girls after puberty, when menstruation is expected to begin. Because of its symptoms and potential complications, early recognition and treatment of false amenorrhea is crucial.
What is False Amenorrhea?
- The ovaries are functioning normally.
- The hormones (FSH, LH, estrogen, progesterone) are secreted in normal amounts.
- The uterus produces menstrual blood monthly.
- The problem: menstrual blood cannot flow out due to an obstruction in the genital tract.
In simple words: the body makes menstruation, but the blood is trapped inside because of a blockage.
Causes of False Amenorrhea (Cryptomenorrhea)
1. Congenital Causes (since birth):
- Imperforate hymen → the most common cause; hymen has no opening.
- Transverse vaginal septum → a horizontal partition inside the vagina preventing menstrual flow.
- Vaginal atresia → absence or closure of the vaginal canal.
- Cervical atresia → congenital absence or blockage of the cervical opening.
2. Acquired Causes (develop later):
- Post-surgical scarring of the cervix or vagina.
- Trauma or infections leading to adhesions.
Symptoms of False Amenorrhea
- Cyclic pelvic pain (monthly pain at the time of menses).
- Lower abdominal swelling due to retained menstrual blood (hematocolpos or hematometra).
- Urinary symptoms such as urinary retention or difficulty in urination.
- Absence of visible menstruation despite secondary sexual characteristics like breast development and pubic hair.
These symptoms usually start after puberty, when menstruation should normally appear.
Diagnosis of False Amenorrhea
Clinical Evaluation
- History: young girl with monthly pelvic pain but no menstruation.
- Examination: bulging imperforate hymen or palpable pelvic mass.
Imaging
- Ultrasound → detects accumulation of blood in the vagina or uterus.
- MRI → helpful in identifying complex cases like transverse septum or cervical atresia.
Differential Diagnosis
- True amenorrhea (hormonal causes).
- Müllerian agenesis (absent uterus).
Complications if Left Untreated
- Hematocolpos → blood trapped in the vagina.
- Hematometra → blood trapped in the uterus.
- Endometriosis → retrograde menstrual flow into the peritoneum, causing chronic pelvic pain and infertility.
- Infections due to stagnant retained blood.
- Future infertility if severe damage occurs to the uterus or fallopian tubes.
Treatment of False Amenorrhea
Treatment is always surgical, aiming to relieve the obstruction and allow normal menstruation. The exact procedure depends on the site of obstruction:
- Imperforate hymen → hymenotomy (small incision to open hymen).
- Transverse vaginal septum → surgical excision of the septum.
- Vaginal atresia → creation of a neovagina (e.g., McIndoe procedure).
- Cervical atresia → cervical dilatation or reconstructive surgery.
With early diagnosis and proper surgical correction, normal menstruation and fertility can usually be preserved.
Summary
False amenorrhea (cryptomenorrhea) is a condition where menstruation happens normally inside the uterus, but blood cannot exit due to an obstruction like imperforate hymen or vaginal septum. It typically presents in adolescents with cyclic pelvic pain but no periods.
Early diagnosis with ultrasound and proper surgical treatment prevents complications like endometriosis and infertility.
FAQs about False Amenorrhea
- Is false amenorrhea a hormonal problem? → No, it is a mechanical blockage.
- At what age does it appear? → Usually after puberty, when menstruation should begin.
- Can false amenorrhea cause infertility? → If untreated, yes. But after surgery, fertility is usually preserved.
- How is it diagnosed? → History, physical exam, ultrasound, or MRI.
- Is treatment complicated? → Most cases, like imperforate hymen, are treated with simple surgery (hymenotomy).