Amenorrhea - Causes, Symptoms & Treatment

What is Amenorrhea?

Despite the disruption in your everyday lifestyle that a regular menstrual cycle causes, it’s a sign that all is well with your body. However, there are some women who do not bleed regularly or have delayed or absent periods during one or more menstrual cycles, which is a condition known as amenorrhea. In simple terms, amenorrhea means no monthly flow, and is a mix of 3 Greek words, a- no, men- monthly, rhoia- flow. 

The problem becomes evident when one misses their monthly cycle more than once, in consecutive months. The reasons for amenorrhea can differ, depending upon one’s age, and may range from physiological changes observed during pregnancy and breastfeeding to even genetic explanations. Owing to that, it is generally believed to be of two kinds: 

• Primary Amenorrhea: which is defined by the lack of development of secondary sexual characteristics in a woman between 14 and 16 years, with no signs of the onset of the menstrual cycle. In such cases, it is found that some girls who have reached puberty, but have not started menstruating, may be due to the fact that it will start late and hence, there is no reason for worry. 
• Secondary Amenorrhea: which is caused by changes in the bodily functions during menopause, and is caused by hormonal disturbances from the hypothalamus and the pituitary gland. This includes women who have been menstruating perfectly in the past but cease to do so between the ages 40 and 55, for a period of 3 months, and 6 months in those women who have a history of irregular menstruation. 

Causes of Amenorrhea

There may be different causes for amenorrhea, depending upon the lifestyle and health of a particular individual. It is important to understand that this condition hits people differently and no two individuals go through the same experience. Therefore, from experiencing amenorrhea as a result of pregnancy to amenorrhea being a by-product of unhealthy stress, following are some of the most common amenorrhea causes: 

It has been observed that certain bodily changes like pregnancy, breastfeeding and menopause alter our monthly cycles, thereby leading to amenorrhea. All of these are natural causes for secondary amenorrhea, but the amenorrhea caused by breastfeeding, in particular, is believed to help young mothers. 

Lactational amenorrhea, as it is also known as, helps women plan a family as it aids in preventing pregnancy within the first 6 months of postpartum. Similarly, amenorrhea during the ages between 40 and 55 years is the sign of menopause and is generally accompanied by heavy back pain. 

Birth control pills effectively work in resetting the period cycle and therefore, for some women, this may not work as intended. So, even if you have stopped taking these pills, chances are that it may take time for regular ovulation or menstruation to occur normally, owing to withdrawal symptoms. This may be observed more in those women who take birth control pills containing progestin hormone, since it works to suppress the endometrium and may lead to secondary amenorrhea. 

Low body weight has been known to be problematic and may cause amenorrhea in some women. Women who do excessive exercise, like ballet, that has a rigorous training routine can often find themselves missing their period for months. This is because not having more than 10% of body fat can interfere with one’s hormonal body functions and potentially halt the ovulation cycle. 

Women with serious eating disorders such as anorexia or bulimia often stop having periods as a result of this imbalance in hormones. Lastly, mental stress can also suppress the functioning of one’s hypothalamus, the area that controls hormones related to menstruation, thereby halting your periods or making them irregular. 

It is no surprise that hormones technically regulate the functioning of one’s periods. From ensuring ovulation to making sure the period finishes its 28-day cycle, hormones control the established flow of menstruation. However, when certain disorders interrupt this balance of the hormones, one can miss their periods for months at a stretch. Problems like PCOS or issues with the thyroid gland can generate rather fluctuating levels of hormones like oestrogen and can cause amenorrhea. 

Sometimes, the reproductive organ can have issues, which may alter or halt one’s menstrual cycle. Asherman’s syndrome is a condition where scar tissue builds up in the lining of the uterus, thereby preventing the normal build up and lining of tissues, which stops periods. 

In other cases, an underdeveloped reproductive organ like the cervix or vagina, can also cause amenorrhea. This condition can also get triggered genetically, so if women in your family have faced abnormal periods in the past, chances are that your risk of getting amenorrhea significantly increases. 

Symptoms of Amenorrhea

The symptoms of amenorrhea vary for individuals. Nonetheless, the main symptom is the absence of periods. However, following are a few more amenorrhea symptoms that will help you understand whether or not your absence of periods can be linked to this disorder: 

• Headache
• Vision Changes 
• Nausea
• Hair Loss
• Milky Nipple Discharge 
• Excessive Facial Hair 
• Pelvic Pain 
• Acne

Diagnosis of Amenorrhea

The diagnosis of amenorrhea is given by a doctor after conducting a thorough medical examination. 

In cases of primary amenorrhea, when a person's periods have never occurred before, the ideal way for a doctor is to check for secondary characteristics. Post this, two things can happen: 

• If those characteristics are present, the ideal way is to wait for some time because, in some women, periods start at a later age. The gynecologist checks the family history to ensure there are no discrepancies to rule out Turner’s Syndrome. 
• In case a woman has not developed secondary sexual characters, the doctor may order further tests to ensure whether she is genetically female or not. 
• Apart from that, tests to verify the presence of reproductive organs like cervix and the vagina are also carried out to assert if the occurrence of amenorrhea isn’t due to the absence of these. 

For secondary amenorrhea, since the most diagnosable causes are pregnancy, thyroid disease or menopause, the doctor may conduct:

• Pregnancy Diagnosis: A pregnancy test is conducted to verify if a woman is pregnant and if it comes negative, the doctor proceeds to look for other plausible causes. 
• Menopause Diagnosis: Ovarian failure or the decline of the ovulating phase in a woman may be considered as the early onset of menopause and can be detected by using a sonography test.  In this case, the doctors can review family history and figure out a way to lead a woman in this new phase of her life. 
• Diagnosis for Hormonal Imbalance: Fluctuating hormones due to thyroid or polycystic ovarian syndrome (PCOS) are checked by mapping out the respective hormone levels or the levels of thyroid stimulating hormone (TSH) or follicle stimulating hormone (FSH) respectively. Post this, medicines are advised accordingly.  

Treatment of Amenorrhea

Treatments are generally based on the kind of amenorrhea you have and what may have triggered it. 

• Usually, the one that is caused due to low body fat or stress can be treated by maintaining healthier lifestyle choices and adapting an appropriate nutrition-based diet.
• If one’s amenorrhea is triggered by eating disorders, using a lifestyle coach and therapy sessions might set them back on track to a healthy period. 
• In cases where amenorrhea is caused by contraceptive pills or owing to hormone fluctuations, it can be treated with the help of a gynecologist. 
• Surgery is rare, but may be needed in cases of genetic or chromosomal defects, to remove pituitary brain tumour or scarring tissue. 

Amenorrhea is a common disorder and nothing to be worried about. Most of the time, it's normal, especially in cases where women are experiencing immense work pressure. Besides, it is curable in most cases and preventable in a lot of them too. All one needs to understand is that there are many women who suffer from the same fate. In such a scenario, it’s important that women suffering from this condition join hands with an aim to provide an open platform for discussions about this issue in order to comfort those affected by amenorrhea so that they understand that there is no stigma to this disorder. 

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