Description

Amenorrhea (uh-men-o-REE-uh) is the absence of menstruation, often defined as the failure of one or more menstrual periods.

Primary amenorrhea refers to the absence of menstruation in someone who has not had a period 15 years of age. The most common cause of primary amenorrhea refers to the levels of the hormone, even though the anatomical problems can also cause amenorrhea.

Secondary amenorrhea refers to the absence of three or more periods in a row by someone who has had periods in the past. Pregnancy is the most common cause of secondary amenorrhea, despite the problems with the hormones can also cause secondary amenorrhea.

The treatment of amenorrhea depends on the underlying cause.

Symptoms

Depending on the cause of amenorrhea, it is possible that the experience of other signs or symptoms, along with the absence of points, such as:

  • Milky discharge from the nipple
  • The loss of hair
  • Headache
  • Changes in vision
  • Excess facial hair
  • Pelvic pain
  • Acne

When to see a doctor

Consult your doctor if you have had at least three menstrual periods in a row, or if you have never had a menstrual period and you are 15 years of age or older.

Causes

Amenorrhea can occur for a variety of reasons. Some are normal, while others may be a side effect of medication or a sign of a medical problem.

Natural amenorrhea

During the normal course of your life, you may experience amenorrhea for natural reasons, such as:

  • Pregnancy
  • Breastfeeding
  • Menopause

Contraceptives

Some people who take birth control pills (oral contraceptives) may not have periods. Even after you stop birth control pills, it may take some time before regular ovulation and menses return. Contraceptives that are injected or implanted can also cause amenorrhea, as some types of intrauterine devices.

Drugs

Certain medications can cause menstrual periods to stop, including some types of:

  • Antipsychotics
  • Cancer chemotherapy
  • Antidepressants
  • Blood pressure drugs
  • Allergy medications

Lifestyle factors

Sometimes, lifestyle factors contribute to amenorrhea, for example:

  • Low body weight. Excessively low body weight — about 10% below the normal weight — interrupts many hormonal functions in the body, potentially stopping ovulation. Women who have an eating disorder, such as anorexia or bulimia, often stop having periods because of these abnormal hormonal changes.
  • Excessive exercise. Women who participate in activities that require rigorous training, such as ballet, may find their menstrual cycles are interrupted. Several factors combine to contribute to the loss of periods in athletes, including low body fat, stress, and high energy expenditure.
  • Stress. Mental stress can alter the functioning of your hypothalamus — an area of the brain that controls the hormones that regulate the menstrual cycle. Ovulation and menstruation may stop as a result. Regular menstrual periods usually resume after your stress decreases.

The Hormonal imbalance

Many types of medical problems can cause a hormonal imbalance, including:

  • Polycystic ovary syndrome (PCOS). PCOS makes it relatively high and sustained levels of hormones, in place of the fluctuations of the levels seen in the normal menstrual cycle.
  • Malfunction of the thyroid. An overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism) can cause menstrual irregularities, including amenorrhea.
  • Tumor of the pituitary gland. A non-cancerous (benign) tumor in your pituitary gland, which can interfere with the hormonal regulation of the menstrual cycle.
  • The premature menopause. Menopause usually begins around the age of 50 years old. But, for some women, the ovarian supply of eggs decreases before 40 years of age and menstruation stops.

Structural problems

Problems with the sexual organs in itself may also cause amenorrhea. Examples include:

  • Uterine scars. Asherman's syndrome, a condition in which the scar tissue builds up in the lining of the uterus, can sometimes occur after a dilation and curettage (D&C), the c-section, or the treatment for uterine fibroids. Uterine scarring prevents the normal of the accumulation and the release of the walls of the uterus.
  • The lack of reproductive organs. Sometimes problems arise during fetal development that lead to the loss of parts of the reproductive system, such as the uterus, cervix or vagina. Because the reproductive system does not develop fully, menstrual cycles are not possible later in life.
  • Structural abnormality of the vagina. An obstruction of the vagina may prevent visible menstrual bleeding. A membrane or wall may be present in the vagina which prevents the outflow of blood from the uterus and the cervix.

Risk factors

Factors that may increase your risk of amenorrhea include:

  • The history of the family. If other women in your family have experienced amenorrhea, may have inherited a predisposition to the problem.
  • Eating disorders. If you have an eating disorder, such as anorexia or bulimia, you are at greater risk of developing amenorrhea.
  • The athletic training. Rigorous sports training can increase your risk of amenorrhea.
  • The history of certain gynecological procedures. If you have had a D&C , especially related to pregnancy, or a procedure known as loop electrodiathermy excision procedure (LEEP), your risk of developing amenorrhea is greater.

Complications

The causes of amenorrhea can cause other problems. These include:

  • Infertility and pregnancy problems. If you do not ovulate and do not have menstrual periods, you can't get pregnant. When hormonal imbalance is the cause of the amenorrhea, this can also cause a miscarriage or other pregnancy-related problems.
  • The psychological stress. Don't have periods when your peers are taking your own can be stressful, especially for young people who are making the transition to adulthood.
  • Osteoporosis and cardiovascular disease. These two problems can be caused by not having enough estrogen. Osteoporosis is a weakening of the bones. Cardiovascular disease includes heart attack, and problems with the blood vessels and the heart muscle.
  • Pain in the pelvis. If an anatomical problem is the cause of the amenorrhea, can also cause pain in the pelvic area.

Diagnosis

During your appointment, your doctor will perform a pelvic exam to see if there are problems with their reproductive organs. If you have never had a period, your doctor may examine your breasts and genitals to see if you are experiencing the normal changes of puberty.

Amenorrhea can be a sign of a complex set of hormonal problems. Find the underlying cause can take time and may require more than one type of evidence.

Tests

A variety of blood tests may be necessary, including:

  • Pregnancy test. This will probably be the first test suggested by your doctor, to rule out or confirm a possible pregnancy.
  • The thyroid function test. The measurement of the amount of thyroid-stimulating hormone (TSH) in the blood can determine if your thyroid works properly.
  • The function of the ovary of the test. The measurement of the amount of follicle-stimulating hormone (FSH) in the blood can determine if the ovaries are functioning properly.
  • Prolactin test. The low levels of the hormone prolactin may be a sign of a tumor of the pituitary gland.
  • The male hormone test. If you are experiencing the increased facial hair and low voice, your doctor may want to check the level of male hormones in the blood.

The hormone challenge test

For this test, you take a medication hormone for seven to 10 days to trigger menstrual bleeding. The results of this test can tell your doctor if your period has stopped due to the lack of estrogen.

Imaging tests

Depending on your signs and symptoms and the result of any blood test that has had — your doctor may recommend one or more imaging tests, including:

  • Ultrasound. This test uses sound waves to produce images of the internal organs. If you have never had a period, your doctor may recommend an ultrasound test to check for any abnormalities in your reproductive organs.
  • Magnetic resonance imaging (MRI). MRI scans use radio waves with a strong magnetic field to produce exceptionally detailed images of the soft tissues within the body. The doctor may order an mri to check if a tumor of the pituitary gland.

Scope of application of the tests

If another test does not reveal any specific cause, your doctor may recommend a hysteroscopy — a test in which a thin, lighted camera is passed through the vagina and cervix to view the inside of your uterus.

Treatment

The treatment depends on the underlying cause of the amenorrhea. In some cases, contraceptive pills or other hormone therapies can restart your menstrual cycles. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a tumor or structural obstruction that is causing the problem, surgery may be necessary.

Lifestyle and home remedies

Some lifestyle factors — such as exercise too much or too little food can cause amenorrhea, to achieve balance in work, leisure and rest. Assess the areas of tension and conflict in your life. If you can't reduce the stress on your own, ask for help from family, friends or your doctor.

Be aware of changes in your menstrual cycle and consult with your doctor if you have concerns. Keep a log of when your periods occur. Note the date of the beginning of the period, how long it lasts and any bothersome symptoms.

Preparing for your appointment

Your first appointment will probably be with your family doctor or gynecologist.

Here's some information to help you prepare for your appointment and know what to expect from your doctor.

What you can do

To prepare for your appointment:

  • Write down details about your symptoms, including when they started, and the date and duration of your last period, if you know when your last period was.
  • Take note of the key medical information, including other conditions for which you are being treated, and the names and doses of the drugs, vitamins or supplements that you take regularly.
  • The review of the history of his family, checking to see if his mother or any sisters have also had problems with menstruation.
  • Write down questions to ask your doctor, listing the most important first in the case of time runs short.

For amenorrhea, some basic questions to ask your doctor include:

  • What could be the cause of that I waste my time?
  • Do I need any tests? How should I prepare for the exams?
  • What treatments are available? What do I recommend?
  • Do you have any brochures on this topic? What sites do you recommend?

What to expect from your doctor

Your doctor will likely ask you a series of questions, such as:

  • When was your last period?
  • Are you sexually active?
  • Could you be pregnant?
  • Do you use birth control?
  • They are under a lot of stress?
  • Has experienced unexplained weight gain or weight loss?
  • The frequency and intensity of exercise?
  • Do you have any other medical condition?
Symptoms and treatment of Amenorrhea