What is Amenorrhea?
Put simply, amenorrhea is when a woman is not having periods. There are two types of amenorrhea, primary and secondary (Fact-1)
Primary amenorrhea is when a girl has not started her period by the age of 16 and has experienced puberty elsewhere in the body. For example, she has grown breasts, pubic hair, and her hips have widened.
Secondary amenorrhea is defined by a woman not having a period for 3 months or more in a row.
There are many causes of amenorrhea, the most common being pregnancy. (Fact-3)
Causes can be natural, due to lifestyle choices, medical issues, or medication, and can include,
- Premature ovarian failure as the ovarian supply diminishes before the age of 40
- Medications including antipsychotics, cancer chemotherapy, antidepressants, and blood pressure drugs
- Medical problems such as PCOS, an over or under reactive thyroid, or a pituitary tumour which is non-cancerous but can interfere with the hormones that are responsible for menstruation
- Problems with the pituitary gland
- Problems with reproductive organs e.g. developmental issues when inside the womb
- Contraceptives can continue to affect periods even after someone has stopped taking them. It may take a while for the body to readjust.
- Lifestyle factors such as poor nutrition
- Low body weight can affect periods. Eating disorders can also cause periods to stop due to changes in the hormones
- Being overweight can cause the body to have too much estrogen which can lead to periods stopping
- Excessive exercise such as ballet and athletic sports can cause periods to stop due to low body fat, stress, and using a lot of energy
- Stress can temporarily alter the functioning of the area within the brain that controls the hormones you need for a regular menstrual cycle
- Heart disease
- Uncontrolled diabetes
- Structural problems caused by scarring in the lining of the uterus, abnormality to the vagina, or a blockage that stops the blood from leaving the vagina
Amenorrhea symptoms will vary depending on the cause (Fact-4). Some of the symptoms include
Missed period for 3 or more months
Milky nipple discharge that is not related to breastfeeding
Excess facial hair
Risk Factors for Amenorrhea
(Fact-5) Some girls and women may be at a higher risk of experiencing amenorrhea if,
- They have a family history of amenorrhea
- Have an eating disorder
- Are undergoing intense athletic training
It can take time to find a cause for your periods stopping, this is because there are so many reasons as to why it could happen (Fact-6).
If the doctor suspects primary amenorrhea then they may examine you and ask questions to check that you are experiencing puberty in other areas of your body. For example, they may ask if your breasts are growing, you have pubic hair, and to see if your hips are widening. The doctor may also check to see if you have any family history of amenorrhea, measure your weight, and ask you some lifestyle questions around your diet, exercise routine, and stress levels.
You may be referred to a gynaecologist or endocrinologist who specialises in treating hormonal conditions.
There are various tests that your doctor can refer you for, such as,
- Pregnancy test if sexually active
- Thyroid function test to measure the amount of thyroid-stimulating hormone (TSH)
- Ovary function test to measure the amount of follicle-stimulating hormone (FSH)
- Prolactin test to see how low the levels of prolactin are as this may be a sign of a pituitary gland tumour (which is non-cancerous)
- Imaging tests such as an ultrasound or CT scan to check the ovaries, uterus, and kidneys
- MRI scan to get a detailed look at the soft tissue
- A blood test may be done to see if you have a large number of male hormones
- Scope test, a thin lighted camera looks at your vagina, cervix, and uterus
The doctor will decide the best way to treat your amenorrhea depending on what is causing your periods to stop.
(Fact-7) Treatments can include,
- Contraceptives or other hormone therapies to help restart periods. This may not deal with the underlying cause of why your periods have stopped
- Medication to treat problems with the thyroid or pituitary gland
- Surgery to remove a tumour or blockage
- Changes to lifestyle, including a balanced approach to work, rest, and play
- Reducing stress
- Change in diet
- Herbal treatments
The Bottom Line
If your periods have not started and you are 16 or above, or your periods have stopped for 3 months or more, it’s a good idea to go and talk to your doctor. There’s no need to feel embarrassed, doctors deal with vaginas, periods, and women’s health concerns every day.
If it helps, take a friend or family member along for support and write down any questions that you may have, along with any known family history of amenorrhea.
It can take a while to find a cause for your amenorrhea due to its many causes. However, the good news is that there are many treatments available, some of which you can put into practice straight away, such as ensuring that you are managing stress, eating a balanced diet to maintain a healthy weight, and not over-exercising.