Amenorrhea

Symptoms: Lack of menstrual periods is the main symptom. Other symptoms may include hot flashes, vaginal dryness, headaches, vision changes, or excessive facial and body hair growth.

Causes: Pregnancy, stress, significant weight loss or gain, and chronic diseases can cause amenorrhea. Hormonal imbalances involving the hypothalamus, pituitary gland, ovaries, and uterus can also lead to amenorrhea.

Risk factors: Factors like rigorous athletic training, history of certain gynecologic procedures, and structural abnormalities of the vagina can increase the risk of amenorrhea.

Prevalence: Among women in their reproductive years, amenorrhea affects 1.5–3% of them. While primary amenorrhea is extremely uncommon, women who are of reproductive age frequently experience secondary amenorrhea.

Which doctor to consult: Gynaecologist

Overview:

Amenorrhea is a condition characterized by the absence of menstrual periods in someone who should be having them. It can be classified into two types:

Primary Amenorrhea: This occurs when a person has not started menstruating by the age of 15.
Secondary Amenorrhea: This is when a person who has had normal menstrual cycles stops getting their period for three months or more.
The causes of amenorrhea can vary from hormonal imbalances to more serious medical conditions. It’s important to consult a healthcare provider if you experience amenorrhea to determine the underlying cause and receive appropriate treatment.

Symptoms:

The symptoms of amenorrhea primarily include the absence of menstrual periods. Depending on the underlying cause, other symptoms may accompany amenorrhea, such as:

Milky nipple discharge
Hair loss
Headache
Vision changes
Excess facial hair
Pelvic pain
Acne

These symptoms can vary, and not everyone will experience all of them. If you’re experiencing any of these symptoms along with missed periods, it's important to consult a healthcare provider.

Causes:

The common causes of amenorrhea include:

Natural Causes:
Pregnancy
Breastfeeding
Menopause
Contraceptives:
Some people may not have periods while taking birth control pills and for some time after stopping them.
Lifestyle Factors:
Stress
Significant weight changes
Excessive exercise
Medical Conditions:
Chronic illnesses
Hormonal imbalances affecting the hypothalamus, pituitary gland, or ovaries
Structural problems with reproductive organs.

Risk factors:

Amenorrhea is associated with several genetic, lifestyle, and health-related risk factors. This is an overview:

Family History: If other women in your family have gone through amenorrhea, you may inherit the predisposition.

Eating Disorders: Amenorrhea risk is increased by eating disorders such as bulimia or anorexia.

Athletic Training: Amenorrhea can occasionally result from intense athletic training.

Body Weight: Menstrual cycles may be impacted by being noticeably underweight or overweight.

Stress: Excessive stress can throw off the hormonal equilibrium required for menstruation.

Genetic Disorders: Genetic or chromosomal disorders that impact the uterus or ovaries may be a contributing factor.

Exercise: Amenorrhea can result from excessive exercise.

Any underlying problems that might be causing amenorrhea must be addressed. If you’re experiencing this condition, consulting a doctor is crucial for proper diagnosis and management.

Possible complications:

The complications of amenorrhea can have significant impacts on health, including:

Osteoporosis: The lack of estrogen associated with amenorrhea can lead to decreased bone density, increasing the risk of fractures.

Cardiovascular Disease: Estrogen is protective against heart disease, so lower levels due to amenorrhea may increase the risk of cardiovascular issues.

Infertility: Amenorrhea can affect ovulation and make it difficult to conceive.

Pelvic Pain: If structural issues are the cause of amenorrhea, it may lead to pelvic pain.

It’s important to address amenorrhea because, while it isn’t life-threatening, it can be a symptom of other health issues that may require treatment.

Prevention:

Maintaining a healthy lifestyle and taking care of any underlying medical conditions are necessary to prevent amenorrhea. Here are a few general pointers:

Keep a Healthy Weight: Your menstrual cycle may be disturbed if you are underweight or overweight.

Consume a Balanced Diet: Ensure you get all the necessary nutrients to help control your menstrual cycle.

Exercise Moderately: While consistent exercise is beneficial, excessive exercise can disrupt your menstrual cycle.

Control Your Stress: Excessive stress can interfere with hormones and cause you to miss periods.

Frequent Examinations: See your doctor on a regular basis, particularly if you experience symptoms of hormonal imbalances or other conditions that may lead to amenorrhea.

When to see a doctor?

If you have experienced irregularities in your menstrual cycle, you have missed three or more periods in a row or had fewer than nine periods in a year. You can also seek guidance from your doctor if a 13-year-old girl is not exhibiting any puberty-related symptoms, such as breast development, or a 16-year-old girl has not yet begun her menstrual cycle.

Diagnosis:

When amenorrhea is diagnosed, a thorough process usually entails the following:

Medical History: A thorough examination of the patient's past health, encompassing symptoms, lifestyle choices, and menstrual cycle patterns.

Physical Exam: A comprehensive examination that includes a pelvic exam to look for any reproductive organ anomalies.

Blood Tests: To check hormone levels, including estrogen, progesterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and thyroid-stimulating hormone (TSH).

Imaging tests: To check for structural problems with the reproductive organs, use methods like ultrasound, MRI, or CT scans.

Genetic Testing: If a chromosomal or genetic condition is suspected as a cause.

A medical professional may also ask about additional symptoms that might point to a pituitary gland issue, like headaches or changes in vision.

Treatment:

The underlying cause of amenorrhea determines how it should be treated. Here are a few broad strategies:

Lifestyle changes: These can be helpful for amenorrhea brought on by stress, weight fluctuations, or overexertion. This includes eating a balanced diet, exercising moderately, and reducing stress.

Medication: Medications used to treat amenorrhea often aim to address hormonal imbalances and can include:

Medroxyprogesterone: A synthetic form of progesterone that can help regulate menstruation and ovulation.

Norethindrone: A type of progestin used in some birth control pills that can help restore menstrual cycles.

Progesterone Supplements: Used to supplement natural progesterone, which can help trigger menstrual periods.

These medications are typically prescribed by a healthcare provider who will consider the specific cause of amenorrhea and the individual’s overall health before recommending a treatment plan.

Surgery: To address the issue of amenorrhea caused by structural abnormalities, surgery may be required.

Treating Underlying Conditions: Appropriate treatment should be given for long-term illnesses or eating disorders that are a contributing factor to amenorrhea.
It's crucial to speak with a healthcare professional to create a customized treatment plan based on the particular cause of amenorrhea.

Additional information:

• Stress can cause primary amenorrhea:

Stress can be a contributing factor to primary amenorrhea. Mental stress can temporarily alter the functioning of the hypothalamus — an area of your brain that controls the hormones regulating your menstrual cycle. As a result, ovulation and menstruation may stop. Typically, regular menstrual periods resume once the stress decreases. It’s important to manage stress and consult a healthcare provider if you’re experiencing amenorrhea to determine the exact cause and appropriate treatment.

• Exercise can affect your menstrual cycle:

Regular exercise can lead to changes such as:

Spotting or Breakthrough Bleeding: This can occur with higher-intensity workouts due to subtle hormone fluctuations.

Missed Periods: Intense exercise can stress the body and interrupt the balance of hormones that drive the menstrual cycle, leading to a condition called exercise-induced amenorrhea.

However, exercise is generally beneficial for regulating the menstrual cycle and flow and may result in less cramping and lighter periods. Maintaining a balance is important, as excessive exercise and a lack of physical activity can impact your menstrual health.