Amenorrhea is when there is no menstruation during the reproductive years, between puberty and menopause. It is not a disease and does not mean that a person is infertile, but it can sign a health problem that needs to be investigated and treated. Menstrual begins around puberty and typically occurs once a month until age 50. At this time, with the onset of menopause, menstruation stops completely. Menstruation also stops during pregnancy, and it is common to stop during breastfeeding.
Types of amenorrhea
There are two types of amenorrhea:
- Primary: Primary amenorrhea is the absence of the first menstruation in a young woman until age 16. If periods do not begin by age 16, the person should seek medical help. Primary amenorrhea is rare. In the United States, it affects less than 0.1 percent of people.
- Secondary: In secondary amenorrhea, periods begin but then stop. Lack of menstruation during pregnancy or breastfeeding is normal, but its absence during other periods from puberty to menopause should be checked. In the United States, secondary amenorrhea is estimated to affect about 4% of women during their lifetime. One missed period is usually not a sign of a health problem, although many people request a pregnancy test if it occurs. In secondary amenorrhea, she already has a regular period but does not have a period for three months, or she has an irregular period before, but there is no period for six months.
How does the menstrual cycle work?
A complex system of hormones controls the menstrual cycle. Every month, hormones prepare the body for pregnancy. Then ovulation occurs. If the woman does not become pregnant, the cycle ends with the shedding of the uterine lining. It is the menstrual cycle. The hormones responsible for this cycle come from different parts of the body. Dysfunction in any of these areas can prevent a person from having a period:
- The hypothalamus controls the pituitary gland.
- The pituitary gland is called the main gland, which produces hormones that cause ovulation.
- The ovaries ovulate and produce the hormones estrogen and progesterone.
- The uterus responds to hormones and prepares the lining.
Amenorrhea Symptoms
In addition to not having a period, depending on the cause of it, there may be other symptoms, including:
- Acne
- Pain in the pelvic area
- Changes in vision
- Headaches
- Hair loss
- More hair growth on the face
- No breast development in primary amenorrhea
- A milky discharge from your nipples
- Nausea
Causes
Amenorrhea can occur for a variety of reasons. Some are normal, while others may be side effects of the drug or a sign of a medical problem.
Natural amenorrhea
During a woman’s normal life cycle, she may develop amenorrhea for natural reasons, including:
- Pregnancy
- Breastfeeding
- Menopause
Contraceptives
Some people who take birth control pills orally may not have a period. Even after stopping birth control pills, regular ovulation and menstruation may take some time to return. Contraceptive drugs that are injected or implanted can also cause the absence of menstruation, and some types of intrauterine devices can also cause amenorrhea.
Medications
Some medications can stop menstruation, including:
- Blood pressure drugs
- Allergy medications
- Antipsychotics
- Cancer chemotherapy
- Antidepressants
Lifestyle factors
Sometimes life factors play a role in causing amenorrhea, for example:
- Low body weight: Being underweight, about 10% below normal weight, interrupts many hormonal functions in the body and potentially stops ovulation. Women with eating disorders, such as anorexia or bulimia, often have periods due to these abnormal hormonal changes.
- Excessive exercise: Women who engage in activities that require careful training, such as ballet, may interrupt their menstrual cycle. Various factors cause the lack of menstrual cycle in women athletes, including low body fat, stress, and high energy consumption.
- Stress: Mental stress can temporarily alter the hypothalamus’ function, an area of the brain that controls the hormones that regulate the menstrual cycle. As a result, ovulation and menstruation may stop. Regular menstrual periods usually resume after stress reduction.
Hormonal imbalance
Various types of medical problems can cause hormonal imbalances, including:
- Polycystic ovary syndrome (PCOS): Polycystic ovary syndrome produces relatively high and stable hormones instead of normal menstrual cycle fluctuations.
- Thyroid malfunction: Hyperthyroidism or hypothyroidism can cause menstrual irregularities.
- Pituitary tumor: Benign tumors in the pituitary gland can interfere with regulating menstrual hormones.
- Premature menopause: Menopause usually begins around the age of 50. But some women experience menopause before age 40, and menstruation stops.
Structural problems
Problems with the sexual organs can also cause amenorrhea, including:
- Uterine scarring: Asherman’s syndrome, a condition in which scar tissue accumulates in the uterus lining, can sometimes occur after dilation and curettage (D&C), cesarean section, or treatment of uterine fibroids. Uterine scars prevent the natural accumulation and shedding of the uterine mucosa.
- Lack of reproductive organs: Sometimes, problems occur during fetal development that lead to the loss of parts of the reproductive system, such as the uterus, cervix, or vagina. Because the reproductive system did not fully develop, menstrual periods do not occur in the future.
- Structural abnormality of the vagina: Vaginal obstruction may prevent visible menstrual bleeding. A membrane or wall in the vagina may prevent blood from flowing out of the uterus and cervix.
Other causes of amenorrhea include:
- Poor nutrition
- Depression
- Sudden weight gain
- Chemo and radiation treatments for cancer
Risk factors
Factors that may increase the risk of amenorrhea include:
- Eating disorders: Women with eating disorders such as anorexia or bulimia nervosa are at higher risk for the absence of menstruation.
- Family history: The presence of amenorrhea can have a genetic cause.
- Athletic training: Intense exercise can cause a lack of menstruation
- History of certain gynecologic procedures
Complications
The absence of menstruation can cause other problems.
Infertility and problems with pregnancy
If menstruation does not occur and ovulation does not occur, pregnancy will not happen. It can also cause miscarriage or other pregnancy problems when hormonal imbalance is the cause.
Stress
Not having periods that other women experience can be stressful, especially for young adults.
Cardiovascular disease and osteoporosis
Osteoporosis and cardiovascular disease can be caused by not having enough estrogen. Osteoporosis causes weak bones. Cardiovascular diseases include heart attacks and problems with blood vessels and heart muscles.
Pelvic pain
If an anatomical problem has caused the absence of menstruation, it may also cause pain in the pelvis.
Diagnosis
Because many things can cause amenorrhea, finding the exact cause can be time-consuming. The doctor reviews the medical history and performs a physical and pelvic examination. It prescribes a pregnancy test to confirm non-pregnancy, then defines other tests.
Blood tests
Some hormones are measured in the blood, including follicle-stimulating, thyroid-stimulating, prolactin, and male hormones. More or less, these hormones can interfere with the menstrual cycle.
Imaging tests
Imaging tests can show abnormalities in the reproductive organs or the location of tumors. These tests include ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).
Hormone challenge test
The doctor prescribes a hormonal drug that should cause menstrual bleeding when women stop taking it. If menstruation does not occur, it means a lack of estrogen in a woman’s body.
Hysteroscopy
One of the best diagnostic methods that, in addition to diagnosis, will be very effective in treating diseases is hysteroscopy. Hysteroscopy is a diagnostic and therapeutic endoscopic procedure that can be treated during diagnosis Hysteroscopy is a procedure in which a small-diameter device is inserted into the uterus. This device has a light and a small camera that allows the doctor to see the uterus inside.
Genetic screening
Investigation of genetic changes that can stop ovarian function
Chromosome tests
Identifies lost, extra, or arranged cells on chromosomes to help identify abnormalities that can cause amenorrhea.
Treatment
Treatment Absence of menstruation will depend on the cause.
Primary amenorrhea
Treatment for primary amenorrhea may be delayed, depending on the person’s age and the result of the ovarian function test. If there is a family history of late menstruation, periods may start on time. Surgery may be needed if genetic or physical problems affect the reproductive organs. However, it does not guarantee that a normal menstrual cycle will occur.
Secondary amenorrhea
It will depend on the root cause.
Lifestyle factors
Changing exercise or diet plans may help stabilize the menstrual cycle if women exercise too much.
Stress
Counseling can help if emotional or mental stress is causing the problem.
Excessive weight loss
It can happen for a variety of reasons. A person may need a professionally supervised weight gain diet. If there is an eating disorder, treatment may include weight gain and consultation with a psychiatrist and a nutritionist or dietitian. Some health conditions can cause weight loss. The doctor may test the cases and get the right treatment.
Underactive thyroid
If menstruation stops due to hypothyroidism, the doctor will treat it as needed.
Polycystic ovary syndrome (PCOS)
The doctor will suggest appropriate treatment. A weight-loss diet may be recommended if PCOS has led to weight gain.
Premature ovary failure
Hormone replacement therapy (HRT) may cause menstruation to return.
Prevention
Preventing amenorrhea is difficult. Try to have a healthy diet and exercise program. If a woman is underweight or overweight, she should try to reach her ideal weight. Women should follow their period every month after menstruation; this can help diagnose the absence of menstruation and early treatment.
Preparing to see a gynecologist
In primary amenorrhea, if a person does not menstruate until the age of 16 and does not have puberty signs, it is better to consult a doctor because this condition may have certain medical causes. If the person is not pregnant or is not menopausal in secondary amenorrhea, it is necessary to see a gynecologist. Some information to help women prepare for a gynecologist visit includes:
- Write down details about your symptoms, when they started, the date, and the last period.
- Note key medication information, such as other conditions you have had while taking it, the name and dose of each medication, and vitamins with supplements you have taken regularly.
- Review your family history to see if your mother or sister has had menstrual problems.
- Write the questions you want to ask the gynecologist; first, write the most important questions due to lack of time.
Some of the basic questions to ask a doctor are:
- What is the reason for not having a period?
- Do I need to take a test? How do I prepare for these tests?
- What treatments are there? Which one do you recommend?
The bottom line
The absence of menstruation is amenorrhea, in which a person has missed one or more periods and has no signs of menstruation. Women who miss at least three periods in a row and do not menstruate have amenorrhea. Girls who do not menstruate until age 15 are also called amenorrhea. Menstrual irregularities can occur for a variety of reasons. Some types of amenorrhea are normal during a woman’s lifetime and do not require treatment. But for others, it may be a side effect of medication or a sign of a problem or illness.
Dr. Arjang Naim, MD, according to his expertise in the field of gynecological problems, thoroughly examines the condition and performs the necessary tests to provide the best treatment solution with a correct diagnosis.
Additional questions
- How do you stop Menometrorrhagia?
Options include skin patches, vaginal rings, pills, shots, and hormonal intrauterine devices (IUDs). These treatments reduce bleeding during the menstrual period. Hormonal birth control can also reduce cramping and pain during menstruation.
- Does amenorrhea mean infertility?
The causes of amenorrhea can also cause other problems. These include: infertility and pregnancy problems. If ovulation and menstruation do not occur, pregnancy does not occur.
- Which drugs are antipsychotics?
Medicines in this category include:
- Risperidone (Risperdal)
- Quetiapine (Seroquel)
- Olanzapine (Zyprexa)
- Ziprasidone (Zeldox)
- Paliperidone (Invega)
- Aripiprazole (Abilify)
- Clozapine (Clozaril)
- What is Asherman’s syndrome?
Asherman syndrome is a rare disease that affects the uterus. In people with this disease, scar tissue or adhesions are formed in the uterus due to injury.
- What is the most common cause of premature ovarian failure?
Chemotherapy and radiation therapy are common causes of ovarian failure caused by toxins. These treatments can damage the genetic material in the cells.
References
https://www.webmd.com/infertility-and-reproduction/guide/absence-periods
https://www.mayoclinic.org/diseases-conditions/amenorrhea/diagnosis-treatment/drc-20369304
https://my.clevelandclinic.org/health/diseases/3924-amenorrhea
https://www.everydayhealth.com/amenorrhea/guide/#diagnosis
https://www.medicalnewstoday.com/articles/215776#takeaway
https://www.sharecare.com/health/amenorrhea/should-doctor-about-amenorrhea