What Is Amenorrhea (Absence of Menstruation)?: Causes and Treatment

What Is Amenorrhea?

Amenorrhea occurs when menstruation ceases despite having undergone puberty, not being pregnant, and not having reached menopause.

It’s distinct from irregular periods; rather, with amenorrhea, menstruation never occurs. Though not a disease itself, it’s important to inform your doctor as it could signal an underlying medical issue that requires attention.

Types of Amenorrhea:

There are two primary types of amenorrhea:

1. Primary amenorrhea: This occurs when young women haven’t experienced their first period by the age of 15.
2. Secondary amenorrhea: This happens when someone has previously had regular menstrual cycles but they cease for three or more consecutive months.

Symptoms of Amenorrhea:

In addition to the absence of menstruation, there are various symptoms depending on the underlying cause of amenorrhea, including:

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1. Pelvic pain
2. Vision changes
3. Headaches
4. Acne
5. Hair loss
6. Increased facial hair growth
7. Milky discharge from nipples
8. Lack of breast development (in primary amenorrhea)

Causes of Amenorrhea:

Amenorrhea can stem from various factors.

For primary amenorrhea (when the first period never occurs), possible causes include:

1. Ovarian failure
2. Central nervous system or pituitary gland issues
3. Reproductive organ problems

Common causes of secondary amenorrhea (when regular periods stop) include:

1. Pregnancy
2. Breastfeeding
3. Discontinuation of birth control
4. Menopause
5. Certain birth control methods like Depo-Provera or specific IUDs

Other causes of secondary amenorrhea encompass:

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1. Stress
2. Malnutrition
3. Depression
4. Certain medications (antidepressants, antipsychotics, etc.)
5. Extreme weight changes
6. Excessive exercise
7. Chronic illness
8. Sudden weight gain or obesity
9. Polycystic ovarian syndrome (PCOS)
10. Thyroid disorders
11. Rare conditions like ovarian or brain tumors
12. Cancer treatments like chemotherapy or radiation
13. Uterine scarring
14. Surgical removal of the uterus or ovaries, leading to cessation of menstruation.

Diagnosing Amenorrhea

Identifying the exact cause of amenorrhea can be a process due to its various potential triggers.

Initially, your doctor will gather your medical history and conduct a thorough physical examination, including a pelvic exam. If sexually active, a pregnancy test may be the first step to exclude pregnancy as a potential cause.

Determining the root cause of your amenorrhea may necessitate several types of tests, such as:

1. Blood tests: These assess hormone levels in your bloodstream, including follicle-stimulating hormone (FSH), thyroid-stimulating hormone, prolactin, and male hormones. Irregular levels of these hormones can disrupt the menstrual cycle.

2. Imaging tests: Ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI) can reveal any abnormalities in your reproductive organs or detect tumors.

3. Hormone challenge test: This involves administering hormonal medication to induce menstrual bleeding upon cessation. Failure to do so may indicate a deficiency in estrogen as the cause of your amenorrhea.

4. Hysteroscopy: This procedure involves inserting a small camera through the vagina and cervix to visualize the interior of the uterus.

5. Genetic screening: This examines genetic alterations that may impair ovarian function and identifies any partial or complete absence of X chromosomes (Turner’s syndrome).

6. Chromosome tests (karyotype): These tests analyze chromosomes for missing, additional, or rearranged cells, aiding in the identification of abnormalities contributing to amenorrhea.

Treatment and Self-care for Amenorrhea

Addressing amenorrhea typically involves treating the underlying cause. Hormone replacement therapy or contraceptives may be prescribed to initiate menstruation. Conditions like thyroid or pituitary disorders may necessitate medication, while physical abnormalities might require surgical intervention.

In cases where factors such as stress, fluctuations in weight, or mood disorders impact menstrual cycles, proactive self-care can be beneficial. Seek support from friends, family, or healthcare providers to manage these influences effectively.

Assist your healthcare provider in identifying the root cause of your amenorrhea by monitoring changes in your cycle and symptoms, and sharing this information. Communicate any alterations in medication, dietary habits, exercise routines, and stress levels to facilitate accurate diagnosis and treatment.