Amenorrhea: Overview
Amenorrhea is a menstrual condition characterized by absent menstrual periods for more than three monthly menstrual cycles, and may be classified as primary or secondary. Primary amenorrhea occurs when menstruation fails to start puberty; secondary amenorrhea is due to some physical cause and usually occurs after normal periods have begun but become increasingly irregular or absent. It is one of many conditions sometimes caused by hormone irregularities, which can be labeled by the more general term, Dysfunction Uterine Bleeding – DUB.
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Ovulation abnormalities are usually the cause of very irregular or frequently missed menstrual periods. If a young woman has not started to menstruate by the age of 16 then a birth defect, anatomical abnormality, or other medical condition may be suspected.
Diagnosis and Tests
Diagnosis begins with a gynecologist evaluating a patient's medical history and a complete physical examination including a pelvic examination. A diagnosis of amenorrhea can only be certain when the physician rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition, a diagnosis of amenorrhea requires that a woman has missed at least three consecutive menstrual cycles, without being pregnant. Young women who have not had their first menstrual period by the age of 16 should be evaluated promptly: making an early diagnosis and starting treatment as soon as possible is very important.
Treatment and Prevention
Specific treatment for amenorrhea will be determined by your doctor based on what is believed to be the cause. Most of the conditions that cause secondary amenorrhea will respond to treatment. In most cases, doctors will induce menstruation in non-pregnant women who have missed two or more consecutive menstrual periods, because of the danger posed to the uterus if the non-fertilized egg and endometrium lining are not expelled. Without this monthly expulsion, the risk of uterine cancer increases.
Signs, symptoms & indicators of Amenorrhea:
Symptoms - Reproductive - Female Cycle
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Risk factors for Amenorrhea:
Circulation
Female-Specific
Polycystic Ovary Syndrome (PCOS)
In many women with polycystic ovaries, menstruation begins at the normal age. After a year or two of regular menstruation, the periods become highly irregular and then infrequent.
Glandular
Hypothyroidism
In many cases, an underactive or overactive thyroid gland is responsible for the absent menstrual cycles.
Habits
The Effects Of Overtraining
Many young female athletes in training experience absent menstrual cycles due to low body fat content. Exercising women with regular menstrual cycles and amenorrheic women who do not exercise excessively demonstrate a clear diurnal rhythm of leptin levels. Exercising women with amenorrhea lose this normal rhythm, which raises the possibility that this cycle is important for the maintenance of reproductive function. Leptin levels normally rise during the afternoon and reach a peak in the early hours of the morning, then decline towards dawn.
For some women, simply explaining the need for adequate calorific intake to match energy expenditure results in increased intake and/or reduced exercise, and their menses resume. For those women in whom no other cause of amenorrhea can be found, but who are unable or unwilling to either increase food intake or decrease the amount of exercise, estrogen replacement therapy is strongly indicated. Appropriate therapy consists of any estrogen replacement regimen that includes endometrial protection.
Metabolic
Problems Caused By Being Overweight
Women who are obese often experience amenorrhea as a result of excess fat cells interfering with the process of ovulation.
Anorexia / Starvation Tendency
Women with anorexia and/or bulimia often experience amenorrhea as a result of maintaining a body weight that would be too low to sustain a pregnancy. As a result, as a form of protection for the body, the reproductive system shuts down because it is severely malnourished.
Nutrients
Supplements, Medications, Drugs
Counter-indicators
Progestin use (confirmed)
Injected progestins have been the standard form of injected contraceptive – and are very effective – but they can have severe effects on the menstrual cycle. Like other progestin contraceptives, Depo-Provera prevents pregnancy by halting ovulation, thickening the cervical mucus, and stopping the implantation of fertilized eggs in the uterine lining.
Tumors, Malignant
Brain Tumor
Although amenorrhea (abnormal cessation of menstruation) is usually explained by something else, in rare cases it can be caused by a brain tumor.
Amenorrhea suggests the following may be present:
Metabolic
Bulimic Tendency
Women with anorexia and/or bulimia often experience amenorrhea as a result of maintaining a body weight that would be too low to sustain a pregnancy. As a result, as a form of protection for the body, the reproductive system shuts down because it is severely malnourished.
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Last updated: Sep 17, 2024