Amenorrhea; Symptoms, Causes, Complications, Treatment, Prevention
Amenorrhea is the absence of menstruation — one or more missed menstrual periods. Women who have missed at least three menstrual periods in a row have amenorrhea, as do girls who haven’t begun menstruation by the age of 16.
The most common cause of amenorrhea is pregnancy. Other causes of amenorrhea include problems with the reproductive organs or with the glands that help regulate hormone levels. Treatment of the underlying condition often resolves amenorrhea.
The main indication of amenorrhea is that you don’t have menstrual periods. Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as:
Milky bosom discharge
Excess facial hair
When to see a doctor
Consult your doctor if you’ve missed at least three menstrual periods in a row, or if you’ve never had a menstrual period and you’re age 16 or older.
Amenorrhea can occur for a variety of reasons. Some are part of the normal course of a woman’s life, while others may be a side effect of medications or a sign of a medical problem.
During the normal course of her life, a woman may experience amenorrhea for natural reasons, such as:
Some women who take birth control pills may not have periods. When oral contraceptives are stopped, it may take three to six months to resume regular ovulation and menstruation. Contraceptives that are injected or implanted also may cause amenorrhea, as can some types of intrauterine devices.
Certain medications can cause menstrual periods to stop, including some types of:
Blood pressure drugs
Stress. Mental stress can temporarily alter the functioning of your hypothalamus — an area of your brain that controls the hormones that regulate your menstrual cycle. Ovulation and menstruation may stop as a result. Regular menstrual periods usually resume after your stress decreases.
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.
Many types of medical problems can cause hormonal imbalance, including:
Polycystic ovary syndrome (PCOS). PCOS causes relatively high and sustained levels of hormones, rather than the fluctuating levels seen in the normal menstrual cycle.
Thyroid malfunction. An overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid gland can cause menstrual irregularities, including amenorrhea.
Pituitary tumor. A noncancerous (benign) tumor in your pituitary gland can interfere with the hormonal regulation of menstruation.
Premature menopause. Menopause usually occurs between ages 45 and 55. In some women, the ovarian supply of eggs diminishes before age 40, and menstruation stops.
Problems with the s*xual organs themselves also can cause amenorrhea. Examples include:
Uterine scarring. Asherman’s syndrome, a condition in which scar tissue builds up in the lining of the uterus, can sometimes occur after a dilation and curettage (D&C), cesarean section or treatment for uterine fibroids. Uterine scarring prevents the normal buildup and shedding of the uterine lining.
Lack of reproductive organs. Sometimes problems arise during fetal development that lead to a girl being born without some major part of her reproductive system, such as her uterus, cervix or v**ina. Because her reproductive system didn’t develop normally, she won’t have menstrual cycles.
Structural abnormality of the v**ina. An obstruction of the v**ina may prevent visible menstrual bleeding. A membrane or wall may be present in the v**ina that blocks the outflow of blood from the uterus and cervix.
Complications of amenorrhea may include:
Infertility. If you don’t ovulate and have menstrual periods, you can’t become pregnant.
Osteoporosis. If your amenorrhea is caused by low estrogen levels, you may also be at risk of osteoporosis — a weakening of your bones.
Treatment depends on the underlying cause of your amenorrhea. In some cases, contraceptive pills can restart your menstrual cycles. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a tumor or structural blockage is causing the problem, surgery may be necessary
Some lifestyle factors can cause amenorrhea, so strive for 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 experience.