A condition when missing one or more menstrual periods is called amenorrhea. It is advised to see a doctor if you are 15 years old and still have not gotten your first period (primary amenorrhea) or periods are missing for three or more months (secondary amenorrhea). In most cases, this is a treatable condition and treatment helps the regular menstrual cycle return.
What is Amenorrhea?
Missing periods in women for at least three months is called amenorrhea. There are 2 amenorrhea types (primary and secondary).
There are different factors that can cause missed periods. In normal circumstances, hormones control the menstrual cycle and they usually prepare the cycle for pregnancy, and if it does not occur you shed your uterine lining. In other words, the menstrual period starts. Check below some organs that can cause irregular or missed menstrual periods:
- Uterus – It responds to the hormones by thickening the uterine lining if there is no pregnancy.
- Ovaries – The organs produce hormones (estrogen and progesterone) as well as store the created egg for ovulation.
- Hypothalamus – This organ controls the pituitary gland which is linked with ovulation.
Amenorrhea Types
Primary Amenorrhea
It is considered a person has primary amenorrhea at roughly 15 years old and has not had the first menstrual period. In most cases, this amenorrhea type is caused by a genetic condition or acquired abnormalities (such as health conditions).
Secondary Amenorrhea
When an individual does not get a menstrual period for at least 3 months or 6 months after irregular periods, secondary amenorrhea occurs. Check below the most common secondary amenorrhea causing-factors:
- Lactation
- Chronic stress or illness
- Pregnancy
How Common is Amenorrhea?
Approximately 1 in 4 females and people assigned to female at birth (AFAB) who are not breastfeeding or pregnant experience amenorrhea at a certain point in their lives.
Symptoms
The primary symptom of amenorrhea is the lack of symptoms. However, people can experience other symptoms related to this condition. Examples include:
- Hot flashes
- Nipples leaking milk
- Vaginal dryness
- Vision changes
- Headaches
- Acne
- Excessive hair growth (especially of the body and face)
In case you experience any of the symptoms listed above and suspect you have amenorrhea, visit a doctor right away.
Causes
Each type of amenorrhea has its causes. In some cases, it occurs naturally while in others it may be a symptom of a serious health condition. Examples of natural causes of amenorrhea include:
- Pregnancy (the most common secondary amenorrhea cause)
- Breastfeeding
- Menopause
- Surgery that removes the uterus or ovaries
Common Primary Amenorrhea Causes
- Genetic or chromosomal issues that impact the reproductive system (such as Turner syndrome)
- Hormonal problems caused by brain or pituitary gland problems
- Underdeveloped reproductive system
- Structural issues (such as missing parts of the vagina or uterus)
Common Secondary Amenorrhea Causes
- Birth control pills (including intrauterine devices, medicines, and others)
- Chemotherapy and radiation therapy (used in cancer treatment)
- Uterine surgery with scarring
- Stress
- Poor nutrition
- Weight changes (extreme weight loss or gain)
- Intense exercise routines
- Some medicines
Additionally, the following health conditions can also provoke this amenorrhea type. Examples include:
- Primary ovarian insufficiency or POI (this is a condition in which ovaries interrupt working before 40 years old)
- Hypothalamic amenorrhea – Hypothalamus problems cause this amenorrhea type.
- Pituitary disorders – These include pituitary tumors, excessive prolactin production, and others.
- Hormonal imbalances – For example, polycystic ovary syndrome, adrenal disorders, hypothyroidism, and others.
- Ovarian tumors
- Obesity
- Certain chronic conditions – Examples include kidney disease, inflammatory bowel disease, and others.
Risk Factors
- Family history of amenorrhea or early menopause
- Chromosomal or genetic disorders of the uterus or ovaries
- Obesity or high in weight people
- Extreme exercising
- Eating disorders
- Chronic stress or health conditions
- Poor diet
Complications
Not treating this condition, may lead to some unpleasant complications. Amenorrhea itself is not life-threatening. Some complications may give you lifelong problems. Examples include:
- Osteoporosis (brittle bones)
- Cardiovascular disease (usually caused by a lack of estrogen)
- Fertility problems (difficulty getting pregnant)
- Pelvic pain
Early diagnosis and treatment can prevent complications and lessen the symptoms. For more details, talk with your physician.
Diagnosis
Doctors will ask you about your periods, symptoms, medical and family history first. Thereafter, can perform physical and pelvic examinations and order some tests that will help to confirm this condition. Check below some examples of tests:
- Pregnancy test
- Blood tests (to check hormone levels or to identify thyroid or adrenal gland diseases)
- Genetic test (is often used to determine whether you have primary ovarian insufficiency before 40 years old)
- MRI (magnetic resonance imaging)
- Ultrasound
Discuss with your healthcare provider for more details.
Treatment
Fortunately, several treatment options are available for amenorrhea. Proper treatment can improve this health condition and reduce the symptoms. Check below some treatment methods:
- Exercise and diet that will help to keep a healthy weight
- Special techniques to manage your stress
- Hormonal treatment prescribed by your physician (usually medicines)
- Surgery
Check below some additional treatments that are used to relieve amenorrhea symptoms:
- Strength training (such as lifting weights)
- Calcium and vitamin D supplements (help to maintain your bones strong)
- Estrogen therapy (usually prescribed to lessen vaginal dryness and hot flashes)
Prevention
Usually, maintaining good overall health can prevent some secondary amenorrhea reasons. Examples include:
- It is advised to be aware of your menstrual periods
- You should also have regular gynecological appointments (including pelvic examination and pap test)
- It is very important to have enough sleep
- Talk with your doctor about a nutritious diet and exercise plan
Frequently Asked Questions
Will my period return?
In most cases, it needs time for regular menstrual periods even if the underlying condition is treated. There are some health conditions that can provoke lifelong amenorrhea. In such cases, you should talk with healthcare providers about fertility methods if you plan to become pregnant.
When should I see my doctor about amenorrhea?
If any of the following cases happens, immediately contact a doctor. For example:
- Excessive body hair growth
- Do not have your first period regardless of whether you are older than 15
- Produce breast milk when you have not given birth
- Trouble with balance or coordination
- Vision problems
How long does amenorrhea last?
Mostly, the regular menstrual periods come right when starting the treatment or treating the underlying disease. However, some people may wait several months until they get their menstrual periods back.
