Have you been experiencing pain in the pelvic region, physical and mental stress?
Have you hit puberty i.e. 15 years of age or you are near your menopause and you are facing an imbalance in your menstrual cycle?
There is a chance you might be facing Amenorrhea.
This article discusses Amenorrhea in detail. Learn about it in detail below.
What is Amenorrhea?
Brain structures, the hypothalamus, and the pituitary gland control the menstrual cycle in your body. The hypothalamus triggers the pituitary gland to make hormones that trigger your ovaries to make oestrogen and progesterone.
These hormones make the lining of your uterus thicker and prepare your body for pregnancy, however, when it does not happen, the hormone level drops and the lining of the uterus comes away. This is A period or menstruation.
Disorders of the hypothalamus, pituitary gland, or ovaries can affect the menstruation cycle and cause amenorrhea.
Amenorrhea is the absence or missing of the menstrual cycle either when a girl hits puberty or you start missing your period while you’re near menopause.
Medically, it is not referred to as a disease or it means that a woman is infertile. It simply means that there is an underlining medical condition that has not yet been attended to.
To put it all in simple words, girls start their menstrual cycle when they reach the age of 15. It continues till the age of 50 until she hits menopause.
During pregnancy, the menstruation cycle stops, and often it is common to stop during the breastfeeding period of a woman.
If in any case, menstruation does not occur other than the above-mentioned reasons that are referred here, is Amenorrhea.
Types of Amenorrhea
As explained by doctors and physicians there are two types of Amenorrhea.
- Primary Amenorrhea
- Secondary Amenorrhea
We’ll explain these two types step by step.
Primary Amenorrhea occurs when a young girl does not have periods when she should have started her cycle by the age of 15.
According to various doctors and health professionals, if periods do not start by the age of 15, one should seek medical help as soon as possible.
Primary amenorrhea is a rare condition and is not observed at early ages of life.
Usually, women miss their menstrual cycle when they are conceiving or when a mother is breastfeeding.
If in any case, periods stop other than the above-mentioned reason, then secondary amenorrhea might be the reason.
In such cases, doctors will consider the following reasons:
- a woman used to have regular periods and they have not occurred for 3 months
- a woman had irregular periods and then have not occurred for 6 months
Other than not having your periods, several symptoms indicate Amenorrhea. These are:
- a person has increased pain in the pelvic region or lower body
- you experience changes in your vision or eyesight
- you may experience a headache often
- menstrual cycle helps remove toxins from a woman’s body due to which one might not have acne, if that is not the case, might have acne or polycystic acne
- hair fall or excessive growth of hair on the body
- discharge from the breast
The causes of Amenorrhea are based on whether it is primary or secondary Amenorrhea.
We will discuss primary and secondary causes separately.
Keep reading to know more.
Causes of Primary Amenorrhea
Primary Amenorrhea is usually the result of an autoimmune or genetic condition in young girls.
The genetic condition that might be the reason for primary amenorrhea is either the normal internal organs were not developed or they do not function properly.
Diseases related to the glands present in the brain that is pituitary gland and hypothalamus can cause primary amenorrhea.
Gonadal dysgenesis is a condition where ovaries are prematurely depleted of hair follicles and oocytes.
This condition leads to the failure of ovaries and is one of the most common reasons for primary amenorrhea.
Another cause of primary amenorrhea is Turner Syndrome.
In this condition, a woman lack all or part of the two X Chromosomes that are normally present in a female.
The ovaries are replaced by scar tissue and estrogen levels are usually at the minimum.
A pituitary tumor can also cause this disease. In this condition, the pituitary gland secretes hormones that directly affect the menstrual cycle
Other causes of primary amenorrhea are:
- Androgen insensitivity: it is a condition in which the male chromosomes are present but do not develop the external characteristics due to lack of response to testosterone and its effects
- Polycystic ovary syndrome (PCOS): it is a condition of abnormal ovarian function and elevated androgen levels
- Congenital adrenal hyperplasia: it is a rare autosomal recessive disorder, in which the body is not able to make enzymes that are required to make the specific hormone
Causes of Secondary Amenorrhea
There are several causes of secondary amenorrhea, one of which is pregnancy and breastfeeding.
Other causes are related to the functions of glands in the brain, ovaries and hormones.
When there is a disruption in the hypothalamus of the brain, they cause changes in hormones. This condition is called Hypothalamic amenorrhea.
Several conditions affect the hypothalamus of the brain. These are:
- Extreme weight loss: when a woman tries to lose excess weight using extreme measure, it might cause secondary amenorrhea
- Stress: in most cases, emotional and physical stress also leads to secondary amenorrhea
- Exercise: due to excessive and rigorous exercise, secondary amenorrhea might be trigged
- Illness: severe illness can also cause amenorrhea
- Eating Disorder: Eating disorder especially anorexia nervosa can affect your menstrual cycle and even cause it to stop.
Hypothalamus usually shuts down when we take extreme measures. It puts our body in the alert level where it tries to maintain balance.
Other medical conditions that cause secondary amenorrhea are:
Tumors in the pituitary gland can lead to increased levels of prolactin, due to which there are high levels of prolactin.
Increased levels of androgens can also lead to amenorrhea. It could be due to excessive male hormones in the body to outside sources.
It is a condition in which the thyroid gland is not able to produce enough hormones.
It is caused due to scarring of the uterine lining of the uterine cavity to manage postpartum bleeding or infection.
Birth Control Pills
In some cases, birth control pills can also cause amenorrhea. Contraceptives or implanted also may cause this problem, so can some types o IUDs.
Sometimes, amenorrhea can cause further complications in females. These are:
Infertility: If a woman does not ovulate and doesn’t have menstrual periods, she cannot conceive. Hormonal imbalance can cause miscarriage and other pregnancy-related problems, according to Mayo Clinic.
Osteoporosis: Due to hormonal imbalance, osteoporosis can be diagnosed in women which can further complicate the problem.
Pelvic pain: in case of an anatomical problem, pain in the pelvic region is caused, according to Mayo Clinic.
Psychological Stress: often seen in younger people, not having a regular menstrual cycle can lead to elevated levels of stress.
It may be time-consuming for your doctor to diagnose the exact cause of amenorrhea as it can happen because of several reasons.
At first, the doctor takes the medical history of the patient and later pelvic examination takes place.
Your doctor may carry out a pregnancy test to see if you are conceiving thus, facing amenorrhea.
It may take several tests by the doctor or physician to know the causes of the condition. He or she might use one or a combination of the following tests
A blood test measures the number of certain hormones in your blood and whether their imbalance causes amenorrhea.
Too much or too little of these hormones can interfere with the menstrual cycle.
These hormones are follicle-stimulating hormone (FSH), thyroid-stimulating hormone, prolactin and male hormones.
Hormone Challenge Test
Your doctor may prescribe a medication that would cause menstrual bleeding and when you stop taking it you won’t bleed.
This means that the androgen levels in your body are low.
Imaging tests like ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI) show any abnormalities of a woman’s reproductive organs.
This test includes testing for missing X chromosomes or identifying any other genetic abnormalities and reasons
A small camera is put into the vagina and cervix to look at the insides of the uterus.
This test helps identify whether a person has missing, extra or rearranged cells in the chromosomes.
The treatment of amenorrhea depends on the underlying medical conditions and their causes.
In some of the cases, a family history of delayed menstruation is common and can be cured with lifestyle changes.
The goal of these treatments is to cure the hormonal imbalance, prevent complications, and regulate the menstruation cycle or achieve fertility.
Your doctor may recommend surgery if the test diagnosis shows genetic or anatomical abnormalities that are causing the issue especially in the case of primary amenorrhea.
In most of the cases, weight gain and intense exercise is the cause of the condition.
You can cure this by incorporating lifestyle changes such as exercise and setting a new routine.
You can cure emotional and physical stress by meditation or simple exercise.
Moreover, Hormone therapy is recommended by doctors or physicians to avoid the symptoms of estrogen depletion as well as osteoporosis which is caused due to low levels of estrogen.
This may consist of a doctor prescribing contraceptive pills or alternative estrogen and progesterone medications.
Young women with premature ovarian failure can benefit from postmenopausal therapy to prevent bone loss.
If the cause of amenorrhea is the higher or lower activity of the thyroid gland, the doctor may prescribe thyroxine.
It is a medication that regulates the production of thyroid in our body.
Excess weight is often the cause of polycystic ovarian syndrome (PCOS). The doctor may suggest a weight loss diet and some medication to regulate the cycle and manage the symptoms of PCOS.
If your doctor removes uterine fibroids through dilation or C-section in uterine scarring then tissues are removed to diagnose or treat heavy bleeding or to clear the lining of the uterus.
This can help in restoring the menstrual cycle.
Amenorrhea is not a disease itself but is a cause of the disease that has not been diagnosed. Proper diagnosis of underlining cause and their treatment can prevent amenorrhea.
However, it cannot be prevented if genetic or inborn conditions are the cause
If your excess weight is the cause then you can treat it with lifestyle changes and exercise.
You should monitor yourself carefully to notice certain changes that indicate amenorrhea. Complete knowledge of family history might help in the situation.
In case of other underlining causes like a tumor or hormonal imbalance, one should take an immediate appointment with the doctor to prevent any further complications.
To prevent unpleasant side effects of amenorrhea, medical and hormonal therapies can be of great use in many women.
Therefore visit your doctor timely to treat amenorrhea appropriately.
Dr Amal Al-Qedrah is a leading gynecologist in Sharjah who can treat your condition and gynecological problems efficiently.
Reach out to us to book your appointment!