Amenorrhea

What is Amenorrhea?
Amenorrhea is the absence of menstruation. It is defined as missing one or more menstrual periods.

• Primary Amenorrhea: When a girl has not started menstruation by age 15.
• Secondary Amenorrhea: When a woman who has had regular periods misses at least three periods in a row.

The most common cause is pregnancy, but it can also signal problems with reproductive organs or hormonal regulation.

Symptoms

The main sign is the absence of your period. However, depending on the cause, you may experience:

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

⚠️ WHEN TO SEE A DOCTOR
Consult your doctor if you have missed at least three menstrual periods in a row, or if you have never had a menstrual period and you are age 15 or older.

Causes

Amenorrhea can occur for a variety of reasons, ranging from normal life changes to medical issues.

1. Natural Causes

• Pregnancy.
• Breast-feeding.
• Menopause.

2. Lifestyle Factors

• Low Body Weight: Being 10% under normal weight interrupts hormonal functions, halting ovulation. Eating disorders like anorexia are common causes.
• Excessive Exercise: Rigorous training (like ballet or long-distance running) combined with low body fat and stress can stop periods.
• Stress: Mental stress can alter the hypothalamus, the brain area controlling menstrual hormones.

3. Medications & Contraceptives

• Birth Control: Pills, injections, or IUDs can stop periods. It may take time for ovulation to return after stopping them.
• Other Drugs: Antipsychotics, chemotherapy, antidepressants, and blood pressure drugs.

4. Hormonal Imbalance

• PCOS (Polycystic Ovary Syndrome): Causes high and sustained hormone levels rather than normal fluctuations.
• Thyroid Malfunction: An overactive or underactive thyroid can cause irregularities.
• Pituitary Tumor: A benign tumor can interfere with hormonal regulation.
• Premature Menopause: Menopause starting before age 40.

5. Structural Problems

• Uterine Scarring (Asherman's Syndrome): Scar tissue prevents the normal buildup of the uterine lining.
• Lack of Reproductive Organs: Problems during fetal development may lead to missing parts of the reproductive system.
• Structural Abnormalities: Blockages in the vagina can prevent visible menstrual bleeding.

Understanding the Cycle: How Ovulation Works

To understand why periods stop, it helps to understand how they start:

1. The pituitary gland stimulates the ovary to release an egg (Ovulation).
2. The egg travels through the fallopian tube.
3. The uterine lining thickens in preparation for pregnancy.
4. If the egg is fertilized, it implants in the uterus (Pregnancy).
5. If not fertilized, the lining sheds about two weeks later. This shedding is Menstruation.

Amenorrhea occurs when any part of this chain is broken.

Complications

• Infertility: If you don't ovulate, you cannot get pregnant.
• Osteoporosis: If amenorrhea is caused by low estrogen, you are at risk of weak, brittle bones.

Diagnosis

Finding the underlying cause often requires multiple tests:

• Lab Tests: Pregnancy test, Thyroid function test, and Hormone tests (FSH, Prolactin, Male hormones).
• Hormone Challenge Test: Taking medication to see if it triggers bleeding.
• Imaging: Ultrasound, CT, or MRI to check internal organs.
• Hysteroscopy: A lighted camera to check the inside of the uterus.

Treatment

Treatment depends entirely on the cause:

• Lifestyle Changes: Improving diet, reducing stress, or balancing exercise.
• Hormone Therapy: Birth control pills or estrogen therapy to restart cycles.
• Medications: To treat thyroid or pituitary disorders.
• Surgery: Required for tumors or structural blockages.

Disclaimer: The content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician regarding any medical condition.