What is Amenorrhea?
According to the Mayo Clinic, amenorrhea (pronounced uh-men-o-REE-uh) is the absence of menstruation or missing at least one menstrual period. This includes girls who have not begun having periods by age 15, as well as women who miss at least three periods in a row after having normal menstrual cycles.
Women may be more at risk of amenorrhea if they have a family history of it, if they have an eating disorder, or if they participate in strenuous athletic training. According to the American Society for Reproductive Medicine, pregnancy is the primary cause of amenorrhea. Other normal life events such as breastfeeding and menopause also cause amenorrhea. Approximately three to four percent of women will experience amenorrhea from other cause during their lifetime.
Symptoms and Complications of Amenorrhea
The most obvious symptom of amenorrhea is a missed menstrual period. However, according to the Mayo Clinic, other symptoms may also occur depending on the reason for the amenorrhea. These might include:
- Excess facial hair
- Pelvic pain
- Milky nipple discharge
- Hair loss
- Vision changes
It is important to contact a gynecologist if a girl has not begun menstruating by age 15, or if a woman has missed at least three periods in a row.
What Causes Amenorrhea
While pregnancy is the most obvious cause of amenorrhea, the National Institutes of Health (NIH) advises women that the condition may be a side effect of some medicines or it can be an indication of other medical problems. Women need to see a doctor to understand the cause of the issue and determine the course of treatment as soon as possible.
Women who use birth control pills, patches or injections may not have regular periods, even after stopping their use. Some IUDs also interfere with normal menstruation. Other types of medications can cause periods to stop or be irregular, including some forms of:
- Allergy medications
- Antipsychotic medications
- Blood pressure medications
- Chemotherapy for cancer
The NIH lists some lifestyle factors that may lead to amenorrhea. These include:
- Body weight below 10% of normal weight. Extremely low body weight interferes with normal hormone functions, which can stop ovulation and menstruation. For this reason, women with eating disorders often experience amenorrhea.
- Strenuous exercise. Women who participate in rigorous exercise and training routines, even dance, may experience irregular or absent menstrual cycles. Doctors believe the combination of high energy expenditure, low body fat and stress contributes to amenorrhea in female athletes.
- Stress, both mental and physical. Stress affects the functioning of the hypothalamus, a part of the brain that controls the hormones which regulate menstrual cycles. When stress decreases, menstrual cycles often return to normal.
Medical problems may also cause amenorrhea, according to the NIH. Some potential medical causes include:
- Premature menopause, or menopause occurring earlier than age 50.
- Problems with the thyroid gland, including hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) affect other hormones in the body.
- Polycystic Ovary Syndrome (PCOS), leading to sustained high level of hormones instead of the normal, cyclic levels of hormones seen in normal menstrual cycles.
- There are other potential causes of amenorrhea, which your gynecologist can detect through exams and tests.
What is the Difference Between Primary Amenorrhea and Secondary Amenorrhea?
Amenorrhea is distinguished by two types, as explained by the National Institutes of Health (NIH). Primary amenorrhea refers to a failure of periods to begin by age 15.
Usually, this occurs due to one of two main causes:
- Chromosome or genetic abnormalities that cause the ovaries to stop working normally.
- Problems with the pituitary or hypothalamus gland in the brain leading to hormone imbalances.
Very rarely, physical problems are to blame for amenorrhea. Missing reproductive organs or blockage of internal passageways can cause primary amenorrhea.
Doctors describe secondary amenorrhea as the case of a woman missing at least three periods in a row after having at least six months of normal cycles. As discussed above, multiple things can cause secondary amenorrhea in women.
Tests and Treatment for Amenorrhea
Doctors first determine the causes of a woman’s amenorrhea before deciding on the appropriate treatment. Amenorrhea caused by hormonal problems, thyroid or pituitary issues can be treated with medications. If there are structural issues, scar tissue in the uterus or tumors, surgery may be required. If the doctor determines lifestyle factors such as stress, exercise or diet are the cause of the amenorrhea, this will be discussed with the patient.
Medical News Today advises women to keep track of their menstrual cycles as well as any symptoms or concerns they have. Women should contact their gynecologists promptly if they miss a period or have other signs or symptoms of a problem. Amenorrhea can be complex, involving hormones, lifestyle and physical issues. Finding the cause might take time and require several different tests.
The doctor may order lab tests, almost always starting with a pregnancy test because this is the primary cause of amenorrhea. If the doctor rules out pregnancy, other tests such as hormone tests, a pelvic exam or other tests may be arranged.