Amenorrhea

Have you ever wondered why some women miss their periods for extended periods? This phenomenon, known as amenorrhea, affects many women worldwide and can have various causes and implications. Amenorrhea is a medical condition characterised by the absence of menstrual periods, which can occur naturally during pregnancy or breastfeeding, but it can also signal underlying health issues that need attention.

This article delves into the complexities of amenorrhea, exploring its types, causes, and symptoms. 

What is Amenorrhea?

Amenorrhea is zero menstruation (missed periods or extended periods) in women of reproductive age. It influences 1.5–3% of women during their childbearing years. 

This condition can result from various factors such as hormonal imbalances, excessive stress, underlying medical conditions, or significant weight fluctuations. 

What are the Types of Amenorrhea?

There are two main amenorrhea types: primary and secondary.

• Primary amenorrhea occurs when a girl hasn't had her first period by age 15. This is a rare condition.
• Secondary amenorrhea happens when a woman who previously had regular periods stops menstruating for three consecutive months or more. It affects approximately 4% of women during their lifetime. 

Causes of Amenorrhea

Amenorrhea has various causes, ranging from natural occurrences to underlying health conditions. The following are some common amenorrhea reasons:

• Pregnancy, breastfeeding, and menopause are common natural amenorrhea causes. 
• Hormonal imbalances, such as those seen in polycystic ovary syndrome (PCOS) or thyroid disorders, can lead to amenorrhea. 
• Lifestyle factors, including excessive exercise, extreme weight loss or gain, and stress, may also disrupt menstrual cycles. 
• Medical conditions like premature ovarian failure, pituitary tumours, and uterine scarring can cause amenorrhea.
• Certain medications, including some birth control methods and antidepressants, may also result in missed periods. 

Symptoms of Amenorrhea

The primary amenorrhea symptom is the absence of menstrual periods. However, women may experience additional signs depending on the underlying cause. These may include: 

• Hot flashes
• Vaginal dryness
• Headaches
• Some individuals might notice milky nipple discharge or vision changes. 
• Excess facial hair growth and acne are also possible symptoms. 
• In cases related to hormonal imbalances, women may experience pelvic pain. 

Risk Factors

Several factors increase the likelihood of developing amenorrhea, such as:

• A family history of amenorrhea or early menopause suggests a genetic predisposition. 
• Eating disorders (anorexia nervosa or bulimia) significantly raise the risk. 
• Excessive exercise and rigorous athletic training can also lead to amenorrhea. 
• Obesity influences hormonal balance and may contribute to the condition. 
• Specific medical procedures, including D&C or loop electro-diathermy excision procedure (LEEP), heighten the risk of secondary amenorrhea. 
• Additionally, genetic factors, such as changes in the FMR1 gene associated with Fragile X syndrome, can play a role in amenorrhea development.

Complications

Amenorrhea influences various aspects of health, leading to potential complications. The following are some common amenorrhea side effects:

• Infertility is a primary concern, as the absence of menstruation often indicates a lack of ovulation. 
• This condition also impacts bone health, increasing osteoporosis risk due to a dip in oestrogen levels. 
• Cardiovascular issues may arise, with amenorrhea patients facing a higher likelihood of heart problems.
• Psychological stress is common, especially among young women comparing themselves to peers. In some cases, amenorrhea causes pelvic pain. 
• Additionally, hormonal imbalances associated with amenorrhea can result in metabolic disorders and affect overall well-being.

Diagnosis for Amenorrhea

Diagnosing amenorrhea involves several steps:

• Your doctor starts with a thorough medical history, including details about menstrual patterns and lifestyle factors. A physical examination and pelvic exam follow. 
• Blood tests check hormone levels, including thyroid-stimulating hormone, follicle-stimulating hormone, and prolactin. 
• Imaging tests like ultrasound or MRI may be used to examine reproductive organs or check for pituitary tumours. 
• In some cases, genetic testing or a hysteroscopy might be necessary. 
• A pregnancy test is often the first step, as pregnancy is a common cause of secondary amenorrhea. 

Treatment for Amenorrhea

The approach to treating amenorrhea depends on its underlying cause. 

• For primary amenorrhea, doctors may recommend watchful waiting if ovary function tests show low hormone levels, as menstruation might be delayed. 
• In cases of secondary amenorrhea, treatments can include hormonal medications like birth control pills or oestrogen replacement therapy. 
• Clomiphene citrate therapy often helps trigger ovulation.
• Rarely, surgery may be necessary, such as removing scar tissue from the uterus or addressing pituitary tumours. 

When to See a Doctor?

Consult a doctor if you've missed three consecutive periods or haven't had your first period by age 15. These situations might indicate amenorrhea, which can be a sign of underlying health issues. Seek advice from your doctor if you experience symptoms like unexplained weight changes, increased facial hair, or changes in your voice. Additionally, if you're sexually active and suspect pregnancy, it's essential to see a doctor. 

Prevention of Amenorrhea

While it's challenging to prevent all forms of amenorrhea, certain lifestyle choices can reduce the risk of secondary amenorrhea. 

• Maintaining a healthy weight, a balanced diet & regular exercise influence hormonal balance and menstrual regularity. 
• Managing stress effectively also plays an elementary role. 
• It is essential to be aware of your menstrual cycle and note any changes. 
• Regular check-ups with a doctor allow for early detection of potential issues. 
• For athletes, finding a balance between training and rest is vital to prevent exercise-induced amenorrhea. 
• Incorporation of some amenorrhea natural treatment options, such as herbal teas, certain food products (ginger, carrots, papaya), yoga, a balanced diet, stress management, and acupuncture, may help stimulate blood flow and regulate reproductive hormones.

Conclusion

Understanding amenorrhea influences women's health management and overall well-being. This condition, characterised by the absence of menstrual periods, can stem from various causes ranging from natural occurrences like pregnancy to underlying health issues. It impacts women of all ages, with different types and risk factors contributing to its development. Recognising the amenorrhea symptoms and potential complications influences early detection and timely intervention.

FAQs

1. How do healthcare providers test for amenorrhea?

Doctors use medical history, examinations, and tests to diagnose the cause and explore options to manage amenorrhea and potentially preserve fertility (if desired).

2. What to do if periods are not coming?

A delayed menstrual cycle necessitates consultation with a healthcare professional. They can help you examine the cause and find treatment, leading to a healthy and regulated cycle.

3. Should I keep track of my periods?

Keeping track of your menstrual cycle influences diagnosing amenorrhea. Use an app or journal to record period duration, last menstruation date, medications, diet and exercise changes, and emotional challenges. This information helps doctors determine the underlying cause of amenorrhea.

4. How long does amenorrhea last?

The duration of amenorrhea varies depending on its cause. With proper treatment, periods typically resume within a few months. However, the exact timeline differs for each individual. 

5. What if periods are late by 10 days?

A late period, by 10 days, can result from stress, weight changes, or hormonal issues. If this is unusual, consider a pregnancy test and consult your doctor.

6. What is the leading cause of amenorrhea?

Amenorrhea has various causes, both natural and medical. Pregnancy is the most common reason behind secondary amenorrhea. Other natural reasons include breastfeeding and menopause. Medical conditions, hormonal imbalances, and lifestyle factors can also lead to amenorrhea.

7. How do I get my period back after amenorrhea?

Treatment focuses on addressing the underlying cause to restore menstruation. This may involve maintaining a healthy weight, managing stress, adjusting exercise levels, or taking prescribed hormonal medications. In rare cases, surgery might be necessary.

8. Can amenorrhea be cured?

In most cases, periods return once the underlying cause is treated. However, it may take time for cycles to become regular again. Some health conditions may result in permanent amenorrhea.

9. Is amenorrhea harmful?

While not life-threatening, amenorrhea can lead to complications if left untreated. These may include osteoporosis, cardiovascular disease, fertility issues, and pelvic pain. 

Dr. Kranthi Shilpa

MBBS, MS (ObGyn), Fellowship in Infertility
CARE Hospitals Outpatient Centre, Banjara Hills, Hyderabad

To Book an Appointment, call:

+91 406 810 6585