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Amenorrhea Overview:

Amenorrhea is a condition in which a female is unable to get her menstrual cycle, even when she should be getting them as per her age and other factors.

Amenorrhea Definition :

If a female has attained puberty, is not pregnant and has not reached the menopause stage, then it is expected that she will get her menstrual cycle on time. Women who are breastfeeding also face the issue of missing their periods, which is common. Amenorrhea is different than having irregular periods because, in case of irregular periods, they do not come on time or come when they are not expected or maybe they would last for an unusual number of days. Whereas in amenorrhea, the female body does not get the periods at all. This is not considered a disease, but there are chances that it could be an abnormal condition which should be reported to the doctor for further diagnosis. The doctor can advise whether the condition is fine for that woman or if it should be treated.

There are essentially two kinds of amenorrhea: Primary and secondary. Primary amenorrhea occurs in young females when they do not get their periods even by the age of 16. Secondary amenorrhea is when a woman who used to have regular or normal periods, stop getting them for three or more than three months in a row. For some, this number could be six instead of three. The existence of primary amenorrhea is not as common as secondary amenorrhea.

Amenorrhea Symptoms :

The most apparent symptom of this condition is the absence of periods for a few months. After that, it depends on the reason why a woman is facing this issue. Based on the causes, there could be a presence of other symptoms as well, some of which are given below:

1.    Hair fall

2.    A headache

3.    Changes in the eyesight/vision.

4.    More hairs on the face than usual.

5.    Milky discharge from the nipples.

6.    Pain in the pelvic area

7.    Acne

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Causes of Amenorrhea :

The causes of primary amenorrhea are different from that of secondary amenorrhea. It is more difficult to diagnose the cause of primary amenorrhea, but some of the reasons could be as follows:

1.    Ovary failure.

2.    Some issue in the nervous system which comprises of the spinal cord and brain.

3.    Problems with the pituitary gland which is responsible for generating that hormone which plays a role in the menstruation.

4.    Problem with the reproductive organs.

In the case of secondary amenorrhea, the list of causes is huge. Apart from normal causes like pregnancy, breastfeeding or menopause, there are many causes which might or might not be considered as normal. For example, a side-effect of some medicine might cause this problem. Below is the list of causes and how they affect the menstruation cycle:

1. Use of contraceptives, in general, can sometimes negatively affect the menstruation of the female body. Taking birth control pills might as well stop the menstrual flow. If the contraceptives are used orally, injected or even implanted, the effect can appear. This also applies to intrauterine devices. It is also noted that when a female stops taking these contraceptives, then also it may take time for their menstrual periods to come back again.

2. There are certain classes of medications which causes amenorrhea. These could be anti-depressants, blood pressure related drugs, any medicines taken to cure allergies, chemotherapy to treat cancer and antipsychotics.

3. Many times lifestyle habits make a difference and can cause amenorrhea. Following factors related to the lifestyle of the woman can cause the problem:

a) Very low body weight- When the body weight is too low, the hormonal system might not function properly. Especially those women who have eating disorders like bulimia or anorexia are prone to an imbalance in their hormonal system.

b) Some women who are involved in excessive physical training or workout face this problem. For example, athletes who do physical exercises every day for a few hours can face this issue. This is because in such cases, stress levels can rise, and the body consumption of energy is also very high. The body weight could also be lower than required.

c) Mental stress: Having mental stress can have a big impact on that part of the brain which is responsible for managing those hormones which control the menstrual cycle. That part of the brain is known as the hypothalamus. Stress can cause amenorrhea or irregular periods as well. When women come out of stress, their periods generally get normal again.

4.    In general, hormonal imbalance is one of the biggest factors behind amenorrhea. There are lots of reasons why this imbalance happens:

a) Most popular reasons for hormonal imbalance in today’s time is PCOS (Polycystic ovary syndrome). This causes the levels of hormones to be higher and maintained. This is not the case for normal menstruation. In normal menstruation cycle, the levels of hormones do fluctuate and vary.

b) When the thyroid gland does not function properly, it can lead to a hormonal imbalance. When the gland is overactive, that condition is known as hyperthyroidism and when those glands are underactive, it is called as hypothyroidism. Both these conditions can not only cause irregular periods but can also cause amenorrhea.

c) There could be a presence of a non-cancerous tumour in the pituitary gland which can disturb the hormonal balance.

d) Premature menopause: The normal age of menopause is around 50. But some women can reach the menopause stage after 40. The eggs might not produce after that age, which causes amenorrhea.

5.    Issues with reproductive and sexual organs can also cause irregular period and even amenorrhea. There are varied types of problems that can happen in the reproductive organs. Some of them are:

a) Abnormality of the vagina: There could be some issue with the structure of the vagina, like the presence of an obstruction which can prevent the blood flow from the uterus and cervix towards the outside.

b) Asherman’s syndrome: In this syndrome, the lining of the uterus builds up a scar tissue. This can happen after dilation and curettage (D&C), a treatment of uterine fibroids or event after caesarean section. This tissue build-up can prevent the normal levels of build-up and shedding.

c) The absence of reproductive organs: This problem is usually by birth where the foetus does not develop part of the reproductive system completely. For example, it could be the absence of the cervix or uterus. These kinds of cases will cause primary amenorrhea because it is scientifically impossible for them to have periods if a vital reproductive organ is missing.

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Amenorrhea Diagnose

The diagnosis of amenorrhea is straight-forward. If a female, who used to have periods before are not having periods for more than 3 months in a row, then they should visit the doctor. For girls who have reached the age of 15 and still did not get their first period, this could be a sign that something might be abnormal and visit a doctor is advised. The doctor would check the weight and ask questions about the female like their medical history and other things like:

1.    The starting age of the menstruation.

2.    If the female is sexually active- which can lead to pregnancy.

3.    If there have been any weight fluctuations or a recent change in lifestyle.

4.    What kind of physical regime do they follow or if there has been a change in it recently?

5.    Questions about the menstrual cycle like a number of days of the cycle, about the amount of flow (whether it is heavy or light) and for how long they last.

Based on that, he may prescribe some tests which can help in finding the cause of missing periods. With the help of the results, the doctor can make out whether it is amenorrhea or something else.

There are various kinds of tests to check for this problem, but it depends on the cause that the doctor has suspected. For example, Ultra-sound of lower abdomen checks the ovaries and their condition. There are also thyroid tests and hormones tests which help in finding out the true picture of the condition of the hormonal system.

Amenorrhea Prevention:

Preventing amenorrhea is not completely in the hands of the female. There could be some reasons which cannot be helped, but if they maintain a healthy lifestyle, then chances of getting amenorrhea are reduced.

1.  Maintaining body weight, taking a healthy diet and not stressing out are some things they can do.

2.  It is also important to keep a check of the cycle and report to the doctor on time without waiting for more months.

3.  Smoking and alcohol consumption should be checked because it can have a very negative impact on the reproductive system of the female body.

4.  If the female is taking some medications which are related to the hormones, like birth control pills or drugs to maintain hormonal levels, then those medications should strictly be taken as prescribed by the doctor. Some of the drugs are to be started from the certain day of the month and these kinds of medications should not be skipped unless specified by the doctor.

5.  Stress is a very harmful condition, not just for the reproductive system, but also for the digestive system. Stress should be avoided and things like meditation, yoga or simple morning or evening walk among nature can help in relaxing and relieving stress. If the conditions are worse, then a counselling session can be very helpful. Those sessions are good as a guide on how to handle difficult situations. Everyone has their own way to feel relaxed and those should not be avoided because of the daily routine.

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Treatment of Amenorrhea :

The treatment of this problem is dependent on the cause. Doctors treat the exact cause of this issue. For example, if there is something wrong with the lifestyle of the female, then the doctors will advise changing it and then see the effect on the body. If the female is going through rigorous exercises, then a change of diet plan might be required so that the body can cope up with that level of physical workout. When women have mental stress, the doctors advise them to go for psychological therapy.

Some women lose a lot of weight in a short amount of time by following rigorous physical regime or change in diet plans. These things should not be done without any professional advice. Consultation with a doctor or a dietician or a certified trainer is highly suggested.

If there is something wrong with the thyroid glands, then doctors prescribe medicines for it.

Many women who have PCOS suffer from irregular periods or amenorrhea. In such cases, losing weight is the most important thing. These days, because of the sedentary lifestyle, this issue has become very common and for its treatment, it is required to get involved in exercises and reduce the fat around the waist and hip area of the body.

Some women also might have to go for hormone replacement therapy, if advised by the doctor.

In case the female body has incomplete or abnormal reproductive organs, then a surgery might help but even the surgery cannot guarantee that they can have normal menstrual periods.

In case the female is near about 40-50 age and even after all the treatments the periods don’t come back, then it might mean that they have reached menopause.

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Complications of Amenorrhea :

Women who face the issue of amenorrhea, also face the following complications:

1.    Infertility: When there are no menstrual periods, it becomes impossible to get pregnant.

2.    Osteoporosis: In case the female body has attained menopause, the chances of getting osteoporosis increases. The chances of this also increase when the estrogen levels are low. In osteoporosis, the bones get weak. Taking calcium supplements might help in this case.

Myths about Amenorrhea:

Myth #1: When women talk about amenorrhea, they think that only those women who are overweight are prone to this problem. This is not completely true. Over-weight women are prone, but so are underweight women as well as those who have a hormonal imbalance due to any other reason. Also, it is believed that once a female recovers from amenorrhea, they will not be able to get pregnant which is false as well. If the periods are normal after recovery, chances of being pregnant are normal as well.

Myth #2 : Most women face issues with their periods at least once in their lifetime. However, if the issues that you face are serious, such as missing periods for 3 or more months then you must consult your gynaecologist and get a diagnosis done for Amenorrhea.

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Last updated on : 26-10-2018

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