Introduction

Most women have a menstruation cycle in their reproductive period. A period is a sign of good health, although the timing, duration, and other details of periods can differ from one woman to the other.

The absence of menstruation in females during the reproductive ages of approximately 12 to 49 years is known as amenorrhea.

Although amenorrhea is not a disease, it may indicate the presence of some medical issues, like hormonal and genetic ones. It is common to experience amenorrhea during puberty, during pregnancy, when nursing, and after menopause.

A complex hormonal system controls the menstrual cycle. Every month, hormone levels fluctuate to prepare the uterus and other reproductive organs for pregnancy.

If all goes well and there is no pregnancy, the uterus releases its lining, which results in a period. But if some aspect of the hormonal system isn’t working correctly, the result can be amenorrhea.

In this blog, we will discuss what amenorrhea is, its types, what are the possible causes, and symptoms, and the treatment for effective management. 

What is Amenorrhea?

A typical woman's menstrual cycle usually lasts for 28 to 30 days and consists of two phases, namely the proliferative and secretory phases.

Towards the end of the cycle, the lining of the uterus starts shedding off, which is a normal process of menstruation. 

Amenorrhea is a medical term used to describe the absence of menstrual periods during a woman's reproductive years.

While pregnancy and breastfeeding are considered normal causes of amenorrhea, this term usually refers to cases where periods are absent due to other factors.

Types of Amenorrhea

There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea.

Primary Amenorrhea: This occurs when a girl has not started her menstrual periods by the age of 16.

Secondary Amenorrhea: This occurs when a woman's menstrual cycle stops for a minimum of three consecutive cycles or six months.

Causes of Amenorrhea

There are many different causes of amenorrhea; some of the most common include:

Pregnancy: This is the most common cause of missed periods.

Hormonal imbalances:  Hormonal imbalances caused by problems with the hypothalamus, pituitary gland, or ovaries can result in amenorrhea. 

Polycystic ovary syndrome (PCOS): This is a condition that affects the ovaries and can cause irregular periods or amenorrhea.

Thyroid problems: Amenorrhea can be caused by both an overactive and an underactive thyroid.

Eating disorders: Eating disorders such as anorexia nervosa and bulimia can disrupt hormone levels, leading to absent or irregular menstrual periods.

Stress: Severe stress can disrupt hormone levels and cause amenorrhea.

Certain medications: Some medications, such as chemotherapy drugs and birth control pills, can cause amenorrhea.

Weight changes: Sudden weight loss or gain can disrupt hormone levels and cause amenorrhea.

Uterine problems: Amenorrhea can be caused by scarring of the uterus or other uterine problems.

Symptoms of Amenorrhea

The main symptom is the absence of menstrual periods. However, amenorrhea may also be accompanied by other symptoms such as: 

Change in breast tenderness: The breast becomes less tender and sensitive.

Change in libido: Some women might experience a change in sex drive.

Headache or vision change: Hormonal imbalance leads to symptoms like headaches or changes in vision.

Excess Hair Growth: Some women may experience excess hair growth on the face, chest, or abdomen due to hormonal imbalances.

Milky Discharge from Breasts: It indicates a hormonal imbalance affecting the menstrual cycle.

Acne or Skin Changes: Hormonal fluctuations can sometimes lead to skin changes like acne or oily skin.

Diagnosis

If you are sexually active and miss your periods, your doctor will recommend a pregnancy test and also perform a pelvic examination.

If you are over the age of 16 and have never had a period, your doctor will review your medical history and perform a pelvic exam to see if you are experiencing puberty or if there are any anatomic abnormalities.

Your doctor will also advise you to undergo the following test to diagnose the cause of amenorrhea:

• Imaging tests will be recommended by your doctor to rule out ovarian tumors and potential birth defects obstructing menstrual flow.
• Blood tests are performed to measure hormone levels, including prolactin, thyroid, and follicle-stimulating hormone (FSH), which can disrupt the menstrual cycle if their levels are too high or too low.

Treatments

Amenorrhea is typically addressed by a gynecologist. If the individual is experiencing anxiety or stress, the gynecologist may refer them to psychiatry or mental health services.

You may need to make some lifestyle changes, such as changes in your diet and physical activities. If emotional or mental stress is a problem, counseling may help in treatment.

Certain hormonal medicines and birth control pills can help trigger menstruation. Other medicines for PCOS can help trigger ovulation.

Hormone therapy may be used to balance out your hormone imbalance. Always consult a physician before taking any medications.

Surgery is done in very rare cases but may be needed in some cases, such as:

• To correct genetic or chromosomal defects.
• To remove a pituitary (brain) tumor.
• To remove uterine scar tissue.

Complications Related to Amenorrhea

If left untreated, amenorrhea may lead to complications such as:

• If you are not ovulating and not having your menstrual periods, it means that you won't be able to get pregnant.
• It can be stressful for young girls who have not yet started menstruating while their peers have already begun.
• Osteoporosis and cardiovascular disease may be caused by insufficient estrogen levels. Osteoporosis weakens bones while cardiovascular disease relates to heart attack and weakens blood vessels and heart muscle.
• If amenorrhea is caused by an anatomical problem, it may cause pain in the pelvic area.

Psychological Impact of Amenorrhea

Amenorrhea can have a significant psychological impact on women. It can lead to feelings of anxiety, depression, low self-esteem, and difficulty with relationships. To deal with these emotional challenges, it is important to ask for support from professionals in the field of mental health.

FAQs

Can amenorrhea be prevented or avoided?

Preventing amenorrhea can be challenging, but maintaining a healthy diet and exercise plan can help. If you are underweight or overweight, talk to your doctor about finding the right balance for you.

Once you start menstruating, keep track of your periods every month. This will help you identify any signs of amenorrhea early and get the right diagnosis and treatment. Keeping track of your periods is also a good practice if you plan on becoming pregnant in the future.

Is amenorrhea a type of infertility?

Amenorrhea is not a type of infertility, but it can affect a woman's ability to get pregnant. If you have irregular or absent menstrual periods and wish to conceive, Consult with your healthcare provider for an appointment. They can evaluate your condition and suggest appropriate measures to help you achieve your goal.

Will my periods ever return?

Yes, for many women with amenorrhea, their periods can return with proper diagnosis and treatment.

Is it normal to have amenorrhea after stopping the pill?

It is common for some people to experience a lack of periods after they stop taking birth control pills, which is known as post-pill amenorrhea. This happens because the body needs time to remember how to produce the hormones necessary for menstruation and ovulation.

It may take up to three months for the body to resume its normal menstrual cycle. If you do not get your period for more than four to six months after stopping the pill, it is important to speak with your healthcare provider.

How do you fix amenorrhea?

The treatment for amenorrhea mainly aims to address the root cause of the condition. This can be achieved through a combination of behavioral modification, medications, surgeries, or a combination of them. For example, in cases where a physical abnormality is blocking the flow of menstrual blood, surgery may be recommended to correct the problem.

Conclusion

In exploring the complexities of amenorrhea, we've delved into its various causes, from hormonal imbalances to lifestyle factors. It is crucial to understand the significance of regular menstrual cycles as indicators of overall health. 

The first step towards the treatment and possible elimination of amenorrhea is to empower yourself with knowledge, whether seeking medical advice for irregularities or making lifestyle changes to achieve a healthy balance.

By staying informed and taking proactive steps towards a healthier lifestyle, we can prioritize our well-being.

References

• Mayo Clinic (2023). Amenorrhea symptoms and causes. Available at https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299. (Accessed 17/12/2023)
  
• Medical News Today (2018). Amenorrhea: types, causes, and treatments. Available at https://www.medicalnewstoday.com/articles/215776. (Accessed 17/12/2023).
• familydoctor.org (2020). Amenorrhea: Symptoms, Causes, and Treatments. Available at https://familydoctor.org/condition/amenorrhea/. (Accessed 17/12/2023).
• National Library of Medicine. (2023). Amenorrhea. Bain J, Bragg S, Ramsetty A, Bradford S. Endocrine Conditions in Older Adults: Menopause. FP Essent. 2018 Nov;474:20–27. [PubMed] [Reference list]. Available at https://www.ncbi.nlm.nih.gov/books/NBK482168/. (Accessed 17/12/2023).
• National Library of Medicine. (2023). Amenorrhea. Rundell K, Panchal B. Being Reproductive. Prim Care. 2018 Dec;45(4):587–598. [PubMed] [Reference list] Available at https://www.ncbi.nlm.nih.gov/books/NBK482168/. (Accessed 17/12/2023).
• Medscape. (2019). Amenorrhea: Background, Pathophysiology, Etiology. Available at https://emedicine.medscape.com/article/252928-overview?form=fpf (Accessed 17/12/2023).