Amenorrhea can happen anytime in life from puberty to later in life. A condition in which you haven't had any menstrual periods by age 16 is called primary amenorrhea. Secondary amenorrhea occurs when you were previously menstruating but then stopped having periods. Pregnancy should be your first consideration if you miss a period, but there are a lot more reasons why you might not be menstruating regularly.Amenorrhea may cause anxiety, but by working with your doctor, you can determine the cause and find ways to regulate your cycle.
Amenorrhea is a symptom, not a disease. It NEVER results from a serious condition. Not knowing the reason menstruation has stopped can be stressful. From your medical history and a description of what you're experiencing, you and your doctor can get to the reason. Treating the underlying reason can resolve amenorrhea.
Depending on the reason of amenorrhea, you might have other signs or symptoms along with the absence of periods, such as headache, vision changes, excess facial hair or hair loss and milky nipple discharge.
Primary amenorrhea affects approximately 1 in 1,000 young girls.
The most common causes of primary amenorrhea include:
Chromosomal abnormalities can cause a premature depletion of the eggs involved in ovulation and menstruation.
Pituitary disease. The pituitary is another gland in the brain that' regulates the menstrual cycle. A tumor or an invasive growth may reduce the pituitary gland's ability to perform this regulatory function.
Lack of reproductive organs. Problems may arise during development of a baby girl resulting in absence of uterus, cervix and/or vagina. Because her reproductive system didn't develop normally, she won't have menstruation.
Structural abnormality of the vagina. An obstruction caused by a membrane or a wall present in the vagina can block the outflow of blood from the uterus and cervix.
Secondary amenorrhea
Secondary amenorrhea is more common than primary amenorrhea.
Possible causes of secondary amenorrhea are:
Pregnancy. In women of reproductive age, pregnancy is the most common cause of amenorrhea.
Contraceptives. When contraceptive pills are stopped, it may take three to six months to resume regular ovulation and menstruation. Contraceptives that are injected or implanted, such as Depo-Provera and implanon may also cause amenorrhea, as can progesterone-containing intrauterine devices eg: Mirena.
Breast-feeding. Mothers who breast-feed experience amenorrhea. Although ovulation may occur, menstruation may not. Pregnancy can result despite the lack of menstruation.
Stress. Mental stress can temporarily alter the functioning of your hypothalamus. Ovulation and menstruation may stop as a result.
Medication. Certain medications such as antidepressants, antipsychotics, some chemotherapy drugs, and oral corticosteroids can cause amenorrhea.
Illness. Chronic illness may delay menstrual periods.
Hormonal imbalance. A common cause of amenorrhea or irregular periods is polycystic ovary syndrome (PCOS). This condition causes relatively high and sustained levels of estrogen and androgen, a male hormone, rather than the fluctuating condition seen in the normal menstrual cycle. This results in a decrease in the pituitary hormones that lead to ovulation and menstruation. PCOS is associated with obesity; amenorrhea or abnormal, often heavy uterine bleeding; acne and sometimes excess facial hair.
Low body weight. Excessively low body weight interrupts many hormonal functions in your body, potentially halting ovulation. Women who have an eating disorder, such as anorexia or bulimia, often stop having periods because of these abnormal hormonal changes.
Excessive exercise. Women who participate in sports that require rigorous training, such as ballet, long-distance running or gymnastics, may find their menstrual cycle interrupted. Several factors combine to contribute to the loss of periods in athletes, including low body fat, stress and high energy expenditure.
Thyroid malfunction. An underactive thyroid gland commonly causes menstrual irregularities, including amenorrhea. Thyroid disorders can also cause an increase or decrease in the production of prolactin — a reproductive hormone generated by your pituitary gland. An altered prolactin level can affect your hypothalamus and disrupt your menstrual cycle.
Pituitary tumor. A noncancerous tumor in your pituitary gland can cause an overproduction of prolactin. Excess prolactin can interfere with the regulation of menstruation. This type of tumor is treatable with medication, but it sometimes requires surgery.
Uterine scarring. Asherman's syndrome, a condition in which scar tissue builds up in the lining of the uterus, can sometimes occur after uterine procedures, such as a dilation and curettage (D and C), Caesarean section or treatment for uterine fibroids. Uterine scarring prevents the normal buildup and shedding of the uterine lining, which can result in very light menstrual bleeding or no periods at all.
Premature menopause. Menopause occurs at an average age of 53. If you experience menopause before age 40, it's considered premature. The lack of ovarian function associated with menopause decreases the amount of circulating estrogen in your body, which in turn thins your uterine lining and brings an end to your menstrual periods.
Although amenorrhea rarely results from a life-threatening condition, it can cover a complex set of hormonal problems. Finding the underlying cause can take time and will require more than one kind of testing.
First, your doctor may have you take a pregnancy test. Your doctor may also perform a pelvic exam to check for pregnancy or any problems with your reproductive organs.
The next step may include blood tests to check your hormone levels, for instance a thyroid function test or evaluation of your prolactin level. A progestin challenge test — in which you take a hormonal medication (progestogen) for seven to 10 days to trigger bleeding Results from this test can tell your doctor whether your periods have stopped due to a lack of estrogen.
Depending on your signs and symptoms and the result of any blood tests you've had , further testing may be needed. Imaging tests, such as computerized tomography, magnetic resonance imaging or ultrasound, can reveal pituitary tumors or structural abnormalities in your reproductive organs.
Finally, laparoscopy or hysteroscopy may sometimes be recommended.
Treatment
The type of treatment you need — if any — depends on what's causing the amenorrhea. Your doctor may suggest that you make changes to your lifestyle depending on your weight, physical activity or stress level. If you have PCOS or athletic amenorrhea, your doctor may prescribe oral contraceptives to treat the problem. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications.
The best way to avoid an interruption in your menstrual cycle is --to maintain a healthy lifestyle:
--Make changes in your diet and exercise activity to achieve a healthy weight.
--Strive for a healthy balance in work, recreation and rest.
--Assess areas of stress and conflict in your life. If you can't decrease stress on your own, ask for help from family, friends or your doctor.
Be aware of changes in your menstrual cycle and check with your doctor if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts and any troublesome symptoms you might experience.
--Talk to your mother, sister or other close female relatives.Gathering this information can help your doctor determine what's causing your amenorrhea.
Amenorrhea may cause anxiety, but by working with your doctor, you can determine the cause and find ways to regulate your cycle.
