Amenorrhea
Amenorrhea means their periods stop, and it can happen for many reasons. About 1 in 4 women experience amenorrhea at some point in their lives, even if they aren't pregnant, breastfeeding or going through menopause.
Doctors recognise two main types of amenorrhea. A person has primary amenorrhea if their first period hasn't started by age 15. The second type happens when someone's periods stop for three or more months after they've had regular cycles. Pregnancy is the most common reason that periods stop, but other things like stress, chronic illness, and hormone problems can make periods stop, too.
Knowing what causes missed periods helps people decide if they need to see a doctor. Doctors suggest that teens should get checked if they haven't had their first period by 15. People should also talk to their doctor if their periods stop for more than three months without any clear reason.
What is Amenorrhea?
The term amenorrhea comes from Greek words that mean "no monthly flow". It describes the absence of menstrual periods in women who can bear children. The normal menstrual cycle needs four distinct body parts to work properly: the hypothalamus, anterior pituitary gland, ovaries, and genital outflow tract.
Types of Amenorrhea
Doctors classify amenorrhea into two main categories:
- Primary amenorrhea: This happens when a girl doesn't get her first period by age 15 or within 3 years after her breasts develop. It affects about 1-2% of women.
- Secondary amenorrhea: The menstrual cycle stops for 3 straight months in women who had regular periods before or for 6+ months in those who had at least one period. This affects roughly 3-5% of women.
Symptoms of Amenorrhea
Women might experience these symptoms besides missed periods:
- Hot flashes and vaginal dryness
- Milky discharge from nipples (galactorrhea)
- Headaches and vision changes
- More facial hair growth
- Acne
Causes of Amenorrhea
Several things can stop menstruation:
- Natural amenorrhea causes: Pregnancy (happens most often), breastfeeding, menopause
- Hormonal imbalances: PCOS, thyroid problems, pituitary tumours
- Lifestyle factors: Too much exercise, dramatic weight changes, high stress
- Structural issues: Uterine scarring, missing reproductive organs, vaginal blockage
- Medications: Birth control, antidepressants, chemotherapy
Risk Factors
People face higher risks if they have a family history of amenorrhea, genetic conditions, extreme weight issues, eating disorders, or exercise too much.
Complications of Amenorrhea
Women who don't treat amenorrhea might face:
Diagnosis of Amenorrhea
Doctors start by gathering a complete medical history. They ask about menstrual patterns, sexual activity, weight changes, exercise habits, medications, and stress levels. A physical exam follows that includes checking reproductive organs.
Tests are the foundations of diagnosis:
- Pregnancy test comes first for sexually active women
- Blood work checks hormone levels (FSH, LH, prolactin, thyroid-stimulating hormone)
- Doctors test male hormone levels if patients notice facial hair or voice changes
Several imaging techniques help doctors see what's happening:
- Ultrasounds reveal reproductive organ issues
- MRI scans detect pituitary tumours
- CT scans show uterine or ovarian problems
Sometimes doctors run a hormone challenge test. This involves taking medication for 7-10 days to trigger menstrual bleeding and shows if oestrogen levels work properly.
Treatment for Amenorrhea
Treatment options change based on what causes the problem:
- Simple lifestyle changes often bring periods back:
- Reaching a healthy weight through better eating
- Cutting back on intense workouts
- Better stress management
- Getting enough calcium (1,000-1,300 mg daily) and vitamin D (600 IU daily)
- Medical treatments match specific conditions:
- Hormone replacement helps ovarian insufficiency
- Birth control pills regulate cycles
- Medications target PCOS or thyroid problems
- Dopamine agonists treat high prolactin levels
- Surgery becomes an option for structural problems like uterine scarring, pituitary tumours, or blocked pathways.
When to See a Doctor
Teens should get checked if they:
- Haven't had a period by 15
- Show no breast development by 13
Adults should see their doctor if they:
- Miss periods for three months straight
- Get headaches, vision changes, or unexpected breast milk
- Notice unusual facial hair growth
Quick diagnosis and the right treatment help avoid long-term problems, especially bone loss. The good news? Treatment works well for most women, though it might take a few months for periods to return regularly.
FAQs
1. Can amenorrhea still get pregnant?
Women can get pregnant even without regular periods. Some conditions that cause amenorrhea might reduce fertility, but conception remains possible. Here's what you should know:
- Women with amenorrhea occasionally ovulate, especially those who have conditions like premature ovarian insufficiency
- Medical treatments that target absent periods can boost pregnancy chances
- Breastfeeding mothers often believe no periods mean they can't get pregnant, but this method isn't reliable
Natural pregnancy becomes harder but not impossible when amenorrhea results from a lack of ovulation. Women who worry about their fertility should see doctors soon, as early detection helps restore normal menstrual cycles.
Women with amenorrhea need contraception if they want to avoid pregnancy since conception can still happen.
2. What is the difference between primary and secondary amenorrhea?
The main difference lies in timing and menstrual history:
- Primary amenorrhea refers to:
- No menstruation by age 15
- Genetic conditions, developmental issues, or delayed puberty often cause this condition
- Secondary amenorrhea involves:
- Three consecutive months without periods in women who had regular cycles
- Six months without periods in women who had at least one previous period
- Pregnancy ranks among other causes like PCOS, hypothalamic amenorrhea, or ovarian insufficiency
3. How to prevent amenorrhea?
Some causes remain unavoidable, but these strategies help lower your risk:
- Weight management: A healthy weight helps maintain hormone balance. Being too thin or overweight can disrupt this balance.
- Stress reduction: Find your stress triggers and work to minimise them. Family, friends, counsellors or doctors can help.
- Exercise balance: Keep physical activity at appropriate levels. Too much training can stop menstrual cycles.
- Track your cycle: Record when periods start and how long they last, and note any problems.
- Healthy lifestyle: Eat a balanced diet, sleep well, and limit alcohol and smoking.
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