What is amenorrhea?
Many women begin menstruation once they reach puberty, typically before reaching the age of 15. Natural changes in the body can delay the point at which a girl has her first menstrual cycle. Older women may also stop getting their period for various reasons.
Amenorrhea is a condition where an adolescent girl or woman stops having menstrual cycles. It can be broken down into two types:
- Primary amenorrhea — An adolescent girl not having a menstrual cycle by the time she turns 15.
- Secondary amenorrhea — An adolescent girl or woman who stops menstruating for at least three months after having previous menstrual cycles.
Primary amenorrhea is typically characterized by having no menstrual flow while showing other signs of puberty. If you have menstruated previously, you may want to see a medical doctor to get checked out for possible secondary amenorrhea if you have any of the following symptoms along with a lack of menstrual cycles:
Causes of amenorrhea
There are two primary reasons why adolescent girls may fail to get their menstrual cycle before turning 16:
Genetic or chromosomal abnormalities — Genetic anomalies can lead to delays or disruption of an adolescent girl’s menstrual cycle. The ovaries may stop functioning normally because of conditions like Turner syndrome or androgen insensitivity syndrome.
Issues with the pituitary gland or hypothalamus — One of the hypothalamus’ most important functions is to regulate hormone releases. The pituitary gland acts as a sort of master control for other glands in the body. Anything that causes an imbalance in the body, like an eating disorder or too much exercise, can disrupt their functions and cause menstruation delays.
Secondary amenorrhea can be caused by natural conditions, like:
The following medications and therapies can also cause secondary amenorrhea:
- Certain birth control pills and other contraceptives
- Chemo and radiation therapy destroying cells and eggs in the ovaries that produce estrogen
Medical conditions that can lead to secondary amenorrhea include:
- Polycystic ovary syndrome (PCOS)
- Fragile X-associated primary ovarian insufficiency (FXPOI)
- Scar tissue build-up in the uterus lining
- Thyroid issues
- Tumors on the pituitary gland
Environmental factors can influence the onset of both primary and secondary amenorrhea, including:
- Being over- or underweight
- Feeling stressed
- Not getting enough physical activity
Diagnosis for amenorrhea
You should visit your doctor if you believe that you may be showing symptoms of amenorrhea. Physicians checking for primary amenorrhea typically start by asking you about your medical history and reviewing your chart. They usually conduct a physical exam that includes checking your pelvis for other signs of puberty.
In suspected cases of secondary amenorrhea, the doctor’s office may first administer you a pregnancy test to rule that out as a cause. From there, they proceed with a review of your health history and a full physical exam. The doctor may also want to order additional tests that help them find the cause of your amenorrhea. That can include:
- Karyotype test that evaluates your chromosomes
- Genetic test to check for any FMR1 gene mutations
- Imaging tests to view your reproductive organs
- Blood testing to check thyroid and ovary function along with testosterone and estrogen levels
Treatments for amenorrhea
Treatment for secondary amenorrhea will vary depending on the root cause. If the reason is mainly environmental, your doctor may recommend lifestyle changes that can make your cycles more regular.
In some cases of secondary amenorrhea, your doctor may recommend the following medications:
Doctors may recommend a wait-and-see approach for primary amenorrhea depending on the patient's age and the outcome of an ovary function test. There may only be a delay in menstruation if there are low levels of follicle-stimulating (FSH) or luteinizing hormone (LH). If the cause of primary amenorrhea is because of genetic issues, surgery may be required.
It is a good idea to start keeping a record of changes in your menstrual cycle once you implement the home care. Stay on top of details, such as when your last period started and ended, how long you were on it, and any other changes you noticed.
Ask your doctor about possible alternative therapies that may help with amenorrhea. It is a good idea to check with them about any supplements or other treatments you may be attempting on your own.
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Possible complications from amenorrhea
Low estrogen levels caused by amenorrhea can possibly lead to medical complications like:
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