All About Amenorrhea

What is amenorrhea? 

Amenorrhea is a condition in which a woman does not get her periods at all or misses multiple periods. It can also be defined as the absence of menstrual periods. The two main types of amenorrhea are  primary and secondary.

• Primary amenorrhea is when a girl or woman does not start menstruating by the age of 15 and faces an absence of menstrual periods.
• Secondary amenorrhea is when a girl or woman misses multiple periods, although she has otherwise been having normal periods.

Is amenorrhea dangerous?

Amenorrhea is not dangerous, but it can lead to certain complications. These include:

• Infertility and pregnancy problems
• Psychological stress
• Osteoporosis (loss of bone density) and cardiovascular disease
• Pelvic pain

What can cause amenorrhea?

There are different reasons for amenorrhea, as explained below:

Contraceptives

Taking oral contraceptives can affect the menstrual cycle and periods. Even once you stop taking the birth control pills, it takes time for the normal menstrual cycle to return. 

Medications

Certain medications can cause your periods to stop. These include:

• Antipsychotics 
• Cancer treatment
• Antidepressant medication 
• Medications for blood pressure
• Medications for allergies 

Lifestyle factors

Certain lifestyle factors can play a role in causing amenorrhea. These include:

• Being underweight – Very low weight can affect normal hormone functions
• Stress – Stress can affect your hypothalamus – the part of your brain that is responsible for releasing hormones that influence your menstrual cycle

Hormonal imbalance

Different kinds of conditions can cause hormonal problems or deficiencies. These include:

• Thyroid malfunction
• Polycystic ovary syndrome (PCOS)
• Pituitary disorder 
• Premature menopause

Structural problems

Structural issues with reproductive organs can also lead to amenorrhea. Examples include:

• Damage to the uterus – This can happen due to a condition called Asherman’s syndrome, in which scar tissue develops in the uterus lining. 
• Absence of certain organs –  This can be caused by issues during foetal development that affects the formation of organs like the uterus or vagina.  

Amenorrhea causes based on types

Amenorrhea can be caused by different factors based on the type.

Primary amenorrhea causes include: 

• Chromosomal or genetic problems with the ovaries 
• Hormonal imbalance or deficiency due to issues with the hypothalamus or the pituitary gland
• Structural issues with reproductive organs 

The causes of secondary amenorrhea include:

• Pregnancy
• Breastfeeding
• Menopause
• Birth control 
• Cancer treatments like chemotherapy and radiation 
• Uterine surgery 

Other causes of secondary amenorrhea can include:

• Stress 
• Poor nutrition 
• Weight change 
• Chronic illness 
• Disorders of the hypothalamus or pituitary gland
• Hormonal conditions like hypothyroidism

What are the symptoms of amenorrhea? 

The main symptom of amenorrhea is a lack of periods. Other amenorrhea symptoms include:

• Hot flashes 
• Dryness in the vagina
• Headaches
• Acne 
• Excess amounts of hair on the face and body 
• Milk leaking from the nipples 

What are the risk factors of amenorrhea?

The risk factors of amenorrhea include the following:

Genetic or family history

If people in your family have amenorrhea or if there is a genetic history of it, you may be more likely to develop it. It is often caused by a change to the FMRI gene. 

Eating disorders 

People who suffer from eating disorders like anorexia or bulimia are at an increased risk of getting this condition.

Gynaecological procedures 

If you have had certain procedures to do with pregnancy or your uterus, the risk is higher. 

Other factors

These include lifestyle or weight issues such as excessive exercise and obesity.

What is the treatment for amenorrhea?

Amenorrhea treatment usually depends on the underlying cause. Birth control pills or hormone treatments can help bring about the menstrual cycle in certain cases. If it is caused by thyroid or pituitary disorders, then medications may be required. If it is caused by a structural blockage or a tumour, then surgery may be required. In case it is caused by stress or weight gain or loss, your gynaecologist may suggest lifestyle changes as a part of the treatment. 

Primary amenorrhea is often caused by a genetic condition called gonadal dysgenesis, in which the gonads (reproductive glands that produce hormones) do not develop properly. In some genetic disorders like Turner syndrome, patients need lifelong hormonal treatment.

Depending on your age and the results of physical exams and various tests, a gynaecologist may suggest ‘watchful waiting’ for primary amenorrhea. If required, this is accompanied by regular check-ups and ovary function tests to help determine the cause. Secondary amenorrhea is commonly treated with hormonal medications to reset the menstrual cycle. Estrogen replacement therapy is also used to balance hormones and revive the menstrual cycle. 

How to diagnose amenorrhea?

Amenorrhea can be diagnosed by various tests. These include: 

• Pregnancy test – This is usually the first test your doctor will suggest to check if you are pregnant instead.
• Thyroid function test – This measures the amount of thyroid-stimulating hormone (TSH) in your blood to determine if your thyroid is functioning properly.
• Ovary function test – This measures the amount of FSH (follicle-stimulating hormone) to check that your ovaries are functioning normally.
• Prolactin test – This helps check if there is an issue with the pituitary gland.
• Male hormone test – Your doctor will suggest this test if you are experiencing increased amounts of facial hair or a deepened voice.
• Hormone challenge test – This checks if you start your periods in response to hormonal medication to determine if there is an estrogen issue. 
• Imaging tests – These include ultrasound tests and magnetic resonance imaging (MRI) scans.
• Scope tests – This refers to a hysteroscopy – a test in which an instrument with a camera is passed through the vagina into the cervix.

When should I see my healthcare provider?

You can consult a doctor if you have missed several periods or if you have never had a menstrual period and are 15 years or older.

Conclusion

If you have missed multiple periods, it is best to visit a gynaecologist to find out if you have amenorrhea and what may be causing it. This condition can affect your fertility because it usually affects your ovulation cycles. 

For the best gynaecological treatment and care, visit the CK Birla Hospital or book an appointment with Dr Shalini Gupta.

FAQs

1. Can amenorrhea be cured?

Amenorrhea can be cured in most cases, depending on the cause. If the underlying cause is treatable, then it can be cured. However, if it is not treatable (such as a hormone issue caused by a uterus surgery), you may need to take hormone treatment for the rest of your reproductive years. 

2. Can I still get pregnant if I have amenorrhea?

In most cases, you will not be able to get pregnant because lack of menses affects your ovulation cycle. However, it would depend on the specific cause of your amenorrhea. 

3. How long can amenorrhea last?

Amenorrhea can last as long as the issue persists. However, if it is caused by a temporary factor such as pregnancy, stress, or lifestyle changes, it may resolve as soon as the situation changes. 

4. Is amenorrhea a disease?

Amenorrhea is not a disease, but it can be a symptom of underlying conditions such as hormonal, genetic, and structural issues. 

5. What causes amenorrhea in PCOS?

In PCOS (polycystic ovary syndrome), amenorrhea is caused by high levels of certain hormones, usually male sex hormones. In people with PCOS, hormone levels are not the usual fluctuating levels as they are in the menstrual cycle.