Side effects of amenorrhea

Menstrual Disorders

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Overview

What Is It?
Menstrual disorders are a disruptive physical and/or emotional symptoms just before and during menstruation, including heavy bleeding, missed periods and unmanageable mood swings.

Some women get through their monthly periods easily with few or no concerns. Their periods come like clockwork, starting and stopping at nearly the same time every month, causing little more than a minor inconvenience.

However, other women experience a host of physical and/or emotional symptoms just before and during menstruation. From heavy bleeding and missed periods to unmanageable mood swings, these symptoms may disrupt a woman’s life in major ways.

Most menstrual cycle problems have straightforward explanations, and a range of treatment options exist to relieve your symptoms. If your periods feel overwhelming, discuss your symptoms with your health care professional. Once your symptoms are accurately diagnosed, he or she can help you choose the best treatment to make your menstrual cycle tolerable.

How the Menstrual Cycle Works
Your menstrual period is part of your menstrual cycle—a series of changes that occur to parts of your body (your ovaries, uterus, vagina and breasts) every 28 days, on average. Some normal menstrual cycles are a bit longer; some are shorter. The first day of your menstrual period is day one of your menstrual cycle. The average menstrual period lasts about five to seven days. A “normal” menstrual period for you may be different from what’s “normal” for someone else.

Types of Menstrual Disorders
If one or more of the symptoms you experience before or during your period causes a problem, you may have a menstrual cycle “disorder.” These include:

  • abnormal uterine bleeding (AUB), which may include heavy menstrual bleeding, no menstrual bleeding (amenorrhea) or bleeding between periods (irregular menstrual bleeding)
  • dysmenorrhea (painful menstrual periods)
  • premenstrual syndrome (PMS)
  • premenstrual dysphonic disorder (PMDD)

A brief discussion of menstrual disorders follows below.

Heavy menstrual bleeding
One in five women bleed so heavily during their periods that they have to put their normal lives on hold just to deal with the heavy blood flow.

Bleeding is considered heavy if it interferes with normal activities. Blood loss during a normal menstrual period is about 5 tablespoons, but if you have heavy menstrual bleeding, you may bleed as much as 10 to 25 times that amount each month. You may have to change a tampon or pad every hour, for example, instead of three or four times a day.

Heavy menstrual bleeding can be common at various stages of your life—during your teen years when you first begin to menstruate and in your late 40s or early 50s, as you get closer to menopause.

If you are past menopause and experience any vaginal bleeding, discuss your symptoms with your health care professional right away. Any vaginal bleeding after menopause isn’t normal and should be evaluated immediately by a health care professional.

Heavy menstrual bleeding can be caused by:

  • hormonal imbalances
  • structural abnormalities in the uterus, such as polyps or fibroids
  • medical conditions

Many women with heavy menstrual bleeding can blame their condition on hormones. Your body may produce too much or not enough estrogen or progesterone—known as reproductive hormones—necessary to keep your menstrual cycle regular.

For example, many women with heavy menstrual bleeding don’t ovulate regularly. Ovulation, when one of the ovaries releases an egg, occurs around day 14 in a normal menstrual cycle. Changes in hormone levels help trigger ovulation.

Certain medical conditions can cause heavy menstrual bleeding. These include:

  • thyroid problems
  • blood clotting disorders such as Von Willebrand’s disease, a mild-to-moderate bleeding disorder
  • idiopathic thrombocytopenic purpura (ITP), a bleeding disorder characterized by too few platelets in the blood
  • liver or kidney disease
  • leukemia
  • medications, such as anticoagulant drugs such as Plavix (clopidogrel) or heparin and some synthetic hormones.

Other gynecologic conditions that may be responsible for heavy bleeding include:

  • complications from an IUD
  • fibroids
  • miscarriage
  • ectopic pregnancy, which occurs when a fertilized egg begins to grow outside your uterus, typically in your fallopian tubes

Other causes of excessive bleeding include:

  • infections
  • precancerous conditions of the uterine lining cells

Amenorrhea
You may also have experienced the opposite problem of heavy menstrual bleeding—no menstrual periods at all. This condition, called amenorrhea, or the absence of menstruation, is normal before puberty, after menopause and during pregnancy. If you don’t have a monthly period and don’t fit into one of these categories, then you need to discuss your condition with your health care professional.

There are two kinds of amenorrhea: primary and secondary.

  • Primary amenorrhea is diagnosed if you turn 16 and haven’t menstruated. It’s usually caused by some problem in your endocrine system, which regulates your hormones. Sometimes this results from low body weight associated with eating disorders, excessive exercise or medications. This medical condition can be caused by a number of other things, such as a problem with your ovaries or an area of your brain called the hypothalamus or genetic abnormalities. Delayed maturing of your pituitary gland is the most common reason, but you should be checked for any other possible reasons.
  • Secondary amenorrheais diagnosed if you had regular periods, but they suddenly stop for three months or longer. It can be caused by problems that affect estrogen levels, including stress, weight loss, exercise or illness.

Additionally, problems affecting the pituitary gland (such as elevated levels of the hormone prolactin) or thyroid (including hyperthyroidism or hypothyroidism) may cause secondary amenorrhea. This condition can also occur if you’ve had an ovarian cyst or had your ovaries surgically removed.

Severe menstrual cramps (dysmenorrhea)
Most women have experienced menstrual cramps before or during their period at some point in their lives. For some, it’s part of the regular monthly routine. But if your cramps are especially painful and persistent, this is called dysmenorrhea, and you should consult your health care professional.

Pain from menstrual cramps is caused by uterine contractions, triggered by prostaglandins, hormone-like substances that are produced by the uterine lining cells and circulate in your bloodstream. If you have severe menstrual pain, you might also find you have some diarrhea or an occasional feeling of faintness where you suddenly become pale and sweaty. That’s because prostaglandins speed up contractions in your intestines, resulting in diarrhea, and lower your blood pressure by relaxing blood vessels, leading to lightheadedness.

Premenstrual syndrome (PMS)
PMS is a term commonly used to describe a wide variety of physical and psychological symptoms associated with the menstrual cycle. About 30 to 40 percent of women experience symptoms severe enough to disrupt their lifestyles. PMS symptoms are more severe and disruptive than the typical mild premenstrual symptoms that as many as 75 percent of all women experience.

There are more than 150 documented symptoms of PMS, the most common of which is depression. Symptoms typically develop about five to seven days before your period and disappear once your period begins or soon after.

Physical symptoms associated with PMS include:

  • bloating
  • swollen, painful breasts
  • fatigue
  • constipation
  • headaches
  • clumsiness

Emotional symptoms associated with PMS include:

  • anger
  • anxiety or confusion
  • mood swings and tension
  • crying and depression
  • inability to concentrate

PMS appears to be caused by rising and falling levels of the hormones estrogen and progesterone, which may influence brain chemicals, including serotonin, a substance that has a strong affect on mood. It’s not clear why some women develop PMS or PMDD and others do not, but researchers suspect that some women are more sensitive than others to changes in hormone levels.

PMS differs from other menstrual cycle symptoms because symptoms:

  • tend to increase in severity as the cycle progresses
  • are relieved when menstrual flow begins or shortly after
  • are present for at least three consecutive menstrual cycles

Symptoms of PMS may increase in severity following each pregnancy and may worsen with age until they stop at menopause. If you experience PMS, you may have an increased sensitivity to alcohol at specific times during your cycle. Women with this condition often have a sister or mother who also suffers from PMS, suggesting a genetic component exists for the disorder.

Premenstrual Dysphoric Disorder (PMDD)
Premenstrual dysphoric disorder is far more severe than the typical PMS. Women who experience PMDD (about 3 to 8 percent of all women) say it significantly interferes with their lives. Experts equate the difference between PMS and PMDD to the difference between a mild tension headache and a migraine.

The most common symptoms of PMDD are heightened irritability, anxiety and mood swings. Women who have a history of major depression, postpartum depression or mood disorders are at higher risk for PMDD than other women. Although some symptoms of PMDD and major depression overlap, they are different:

  • PMDD-related symptoms (both emotional and physical) are cyclical. When a woman starts her period, the symptoms subside within a few days.
  • Depression-related symptoms, however, are not associated with the menstrual cycle. Without treatment, depressive mood disorders can persist for weeks, months or years. If depression persists, you should consider seeking help from a trained therapist.

Diagnosis

To help diagnose menstrual disorders, you should schedule an appointment with your health care professional. To prepare, keep a record of the frequency and duration of your periods. Also jot down any additional symptoms, such as cramping, and be prepared to discuss health history. Here is how your health care professional will help you specifically diagnose abnormal uterine bleeding, dysmenorrhea, PMS and PMDD:

Heavy menstrual bleeding

To diagnose heavy menstrual bleeding—also called menorrhagia—your health care professional will conduct a full medical examination to see if your condition is related to an underlying medical problem. This could be structural, such as fibroids, or hormonal. The examination involves a series of tests. These may include:

  • Ultrasound. High-frequency sound waves are reflected off pelvic structures to provide an image. Your uterus may be filled with a saline solution to perform this procedure, called a sonohysterography. No anesthesia is necessary.

  • Endometrial biopsy. A scraping method is used to remove some tissue from the lining of your uterus. The tissue is analyzed under a microscope to identify any possible problem, including cancer.

  • Hysteroscopy. In this diagnostic procedure, your health care professional looks into your uterine cavity through a miniature telescope-like instrument called a hysteroscope. Local, or sometimes general, anesthesia is used, and the procedure can be performed in the hospital or in a doctor’s office.

  • Dilation and curettage (D&C). During a D&C, your cervix is dilated and instruments are used to scrape away your uterine lining. A D&C may also be used as a treatment for excessive bleeding and for bleeding that doesn’t respond to other treatments. It is performed on an outpatient basis under local anesthesia.

You can also expect blood tests to check your blood count for anemia and a urine test to see if you’re pregnant, as well as other laboratory tests.

The more information you can give your health care professional, the better. Take notes on the dates and length of your periods. You can do this by marking your calendar or appointment book. You might also be asked to keep a daily track record of your temperature to determine when you are ovulating. Ovulation kits, that use a morning urine sample, are available without a prescription and are easy to use.

During your initial evaluation with your health care professional, you should also discuss the following:

  • current medications
  • details about menstrual flow and cycle length
  • any gynecologic surgery or gynecologic disorders
  • sexual activity and history of sexually transmitted diseases
  • contraceptive use and history
  • family history of fibroids or other conditions associated with AUB
  • history of a breast discharge
  • blood clotting disorders—either your own or in family members.

PMS and PMDD

There are no specific diagnostic tests for PMS and PMDD. You’ll probably be asked to keep track of your symptoms and write them down. A premenstrual symptom checklist is one of the most common methods currently used to evaluate symptoms. With this tool, you can track the type and severity of symptoms to help identify a pattern.

Generally PMS and PMDD symptoms:

  • tend to increase in severity as the menstrual cycle progresses.
  • tend to be relieved when menstrual flow begins or soon afterward.
  • are present for at least three consecutive menstrual cycles.

Secondary Amenorrhea

During a normal menstrual cycle, estrogen levels rise. Estrogen is a hormone responsible for sexual and reproductive development in women. High estrogen levels cause the lining of the uterus to grow and thicken. As the lining of the womb thickens, your body releases an egg into one of the ovaries.

The egg will break apart if a man’s sperm doesn’t fertilize it. This causes estrogen levels to drop. During your menstrual period you shed the thickened uterine lining and extra blood through the vagina. But this process can be disrupted by certain factors.

Hormonal imbalances

A hormonal imbalance is the most common cause of secondary amenorrhea. A hormonal imbalance can occur as a result of:

  • tumors on the pituitary gland
  • an overactive thyroid gland
  • low estrogen levels
  • high testosterone levels

Hormonal birth control can also contribute to secondary amenorrhea. Depo-Provera, a hormonal birth control shot, and hormonal birth control pills, may cause you to miss menstrual periods. Certain medical treatments and medications, such as chemotherapy and antipsychotic drugs, can also trigger amenorrhea.

Structural issues

Conditions such as polycystic ovary syndrome (PCOS) can cause hormonal imbalances that lead to the growth of ovarian cysts. Ovarian cysts are benign, or noncancerous, masses that develop in the ovaries. PCOS can also cause amenorrhea.

Scar tissue that forms due to pelvic infections or multiple dilation and curettage (D and C) procedures can also prevent menstruation.

D and C involves dilating the cervix and scraping the uterine lining with a spoon-shaped instrument called a curette. This surgical procedure is often used to remove excess tissue from the uterus. It’s also used to diagnose and treat abnormal uterine bleeding.

Learn more: D and C (dilation and curettage) procedure “

Lifestyle factors

Body weight can affect menstruation. Women who are overweight or who have less than 15 percent body fat may stop getting menstrual periods. This is especially true for athletes who train extensively or excessively.

Emotional stress is another possible cause of secondary amenorrhea. Your body may respond to extreme stress by disrupting your normal menstrual cycle. Your menstrual periods will most likely resume once you work through your tension and anxiety.

Amenorrhea

Your doctor will determine which treatment is right for you based on the cause of your amenorrhea. Treatments include hormone therapy, psychological counseling and support, and surgery, among others.

Drug Therapies

Your health care provider may suggest the following:

  • Birth control pills or hormones to help you start menstruating.
  • Estrogen replacement for low levels of estrogen caused by ovarian problems, hysterectomy, or menopause. Women with an intact uterus should get estrogen plus progesterone. Estrogen, or hormone replacement therapy (HRT), has both benefits and risks. Post-menopausal women who take HRT have higher risk of breast cancer, stroke, heart disease, and blood clots in the lungs. However, for some younger women, the benefits may outweigh the risks. Talk to your doctor to decide what is best for you.
  • Progesterone to treat ovarian cysts and some problems with the uterus.
  • Metformin to treat cysts in the ovaries and support ovulation.

Complementary and Alternative Therapies

Maintaining a healthy weight and exercising regularly can keep your body healthy. Other alternative therapies may help your body make and use hormones properly.

Nutrition and Supplements

Be sure to eat a healthy diet. Limit processed foods, and eat foods with heart-healthy fats (unsaturated fats) rather than saturated fats. Avoid caffeine and alcohol. Eat more whole grains, vegetables, and omega-3 fatty acids found in cold-water fish, nuts, and seeds. Diets that are very low in fat can raise your risk of amenorrhea. In addition, these supplements may help:

  • Calcium, magnesium, vitamin D, vitamin K, and boron. Women who do not have periods are at higher risk of osteoporosis, and these vitamins and minerals may help keep bones strong. Vitamin K can interact with blood-thinning medications such as warfarin (Coumadin) and clopidogrel (Plavix).
  • B6 may reduce high prolactin levels. Prolactin is a hormone released by the pituitary gland, and women with amenorrhea often have higher levels of prolactin.
  • Essential fatty acids: Evening primrose or borage oil. These fatty acids may increase the risk of bleeding, especially if you take blood thinners such as clopidogrel (Plavix) or warfarin (Coumadin).

Progesterone is sometimes available as an over-the-counter oral supplement. However, you should never take progesterone without your doctor’s supervision.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a provider.

Most of the herbs listed below have not been studied specifically for treatment of amenorrhea, but they have been used traditionally. Many act like the hormone estrogen in the body. Talk to your doctor before taking them, and avoid these herbs if you have a history or family history of cancers associated with estrogen, including breast, cervical, uterine, and ovarian cancer.

  • Chaste tree: For high prolactin levels, chaste tree (Vitex agnus-castus) may help the pituitary gland function normally and may reduce prolactin levels, but it must be taken for 12 to 18 months. One very small study found that 10 of 15 women with amenorrhea started having periods after taking chaste tree for 6 months. If you already use hormone therapy, do not use chaste tree except under your doctor’s supervision. Chaste tree may interact with a number of medications, including chlorpromazine (Thorazine), haloperidol (Haldol), levodopa, metoclopramide, olanzapine (Zyprexa), prochlorperazine (Compazine), quetiapine (Seroquel), ropinirole (Requip), and risperidone (Risperdal). It also may make birth control pills less effective.

The following herbs have estrogen-like effects and are sometimes used to treat menopausal symptoms, although there are no clinical trials that show whether they work or are safe. People with a history of hormone-related cancers should consult a physician before using these herbs:

  • Black cohosh (Cimicifuga racemosa), licorice (Glycyrrhiza glabra), and squaw vine (Mitchella repens): Black cohosh may interact with a number of medications processed by the liver, including acetaminophen (Tylenol), atorvastatin (Lipitor), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), and others. Licorice interacts with many prescription and over-the-counter medications, and can potentially cause a variety of side effects, so ask your doctor before taking it. DO NOT take licorice if you have high blood pressure or heart failure.
  • Lady’s mantle (Alchemilla vulgaris) and vervain (Verbena officinalis): These are other herbs that may help stimulate menstrual flow. DO NOT take these herbs without your doctor’s supervision. Your doctor should monitor your liver function if you take lady’s mantle.
  • Kelp (Laminaria hyperborea), oatstraw (Avena sativa), and horsetail (Equisetum arvense): These three are rich in minerals that may help promote thyroid function. Avoid horsetail if you have diabetes, take lithium, or take a diuretic (water pill), such as hydrochlorothiazide or furosemide (Lasix).
  • Wild yam: Some people believe wild yam is a natural source of progesterone, but that is not true. Although it was once used to make progesterone in the laboratory, the body cannot make progesterone from wild yam.

DO NOT take the herb blue cohosh (Caulophyllum thalictroides). This toxic herb should not be used without strict medical supervision.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for amenorrhea based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type, which is your physical, emotional, and intellectual makeup.

  • Pulsatilla: For most menstrual problems, especially in women who have poor appetite and do not favor exertion; they may faint easily. They may be aggravated by heat and feel worse in the evening. They may like to be in the open air.
  • Sepia: For women with late or irregular menstruation. They may have a sallow complexion and experience frequent headaches, toothaches, and pain when bearing down. They may feel cold and want to be alone.
  • Graphites: For women with late or light menstruation. They may have a sallow complexion and experience a feeling of fullness or constipation and headaches. They often have a fair complexion.

Physical Medicine

The following help increase circulation and relieve pain from pelvic congestion:

  • Castor oil pack: Apply oil to a soft, clean cloth, place on abdomen, and cover with plastic wrap. Place a hot water bottle or heating pad over the pack and let sit on your abdomen for 30 to 60 minutes. You can safely use this treatment for 3 days, although it may be beneficial to use for longer. Talk to your provider to determine how long to use it.
  • Contrast sitz baths: Use two basins that you can comfortably sit in. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat this 3 times to complete one “set.” Do 1 to 2 sets per day, 3 to 4 days per week.

Acupuncture

Acupuncture may improve hormonal imbalances that can go along with amenorrhea and related conditions, such as polycystic ovary syndrome (PCOS). A few small studies of women with fertility problems, which are sometimes connected with amenorrhea, suggest that acupuncture may help promote ovulation.

Acupuncturists treat people with amenorrhea based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. Acupuncturists believe that amenorrhea is often associated with liver and kidney deficiencies, and treatment often focuses on strengthening function in these areas.

Jump to: Causes Diagnosing Amenorrhea Treatment

If a teenaged girl doesn’t get her period by the age of 16, she has primary amenorrhea (or absence of menses), which is typically caused by structural or chromosomal abnormalities or functional problems with the hypothalamus or pituitary gland. But when a woman who’s previously had her period stops menstruating for three months or longer, and she’s not pregnant or in menopause, it’s called secondary amenorrhea. While secondary amenorrhea can have many causes, it’s important for a woman to find out why her periods have stopped.

“Ovulation is a vital sign of general good health,” says Nathan Kase, MD, professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai Medical Center in New York City. “Almost every organ in the body can disrupt the cascade that initiates and sustains normal menstrual cycles.”

“It’s not normal for a woman to not have periods,” says Cynthia Austin, MD, an obstetrician/gynecologist at the Cleveland Clinic in Ohio. “When a woman isn’t getting her period, it means she’s not ovulating regularly, and it’s important to learn why.”

Amenorrhea can lead to bone loss, including osteoporosis, says Mitchell S. Kramer, MD, chairman of the department of obstetrics and gynecology at Northwell Health’s Huntington Hospital in Huntington, New York. “Infertility is certainly another risk as well,” he says.

The good news, says Dr. Kase, is that nearly all amenorrhea in this country is reversible. Also, it’s not uncommon for a woman to miss a few periods now and then, so she shouldn’t automatically assume something is wrong. “It is not unusual in our society for a woman to have intervals of irregular periods and it doesn’t necessarily mean they have a serious disease,” Dr. Kase says. “But if it doesn’t spontaneously return, generally within six months, very accurate methods are readily available to identify, stabilize, and, if necessary, manage the situation positively with treatment.”

What Causes Amenorrhea?

When a woman is ovulating regularly, she is making enough of a hormone called estrogen that promotes uterine lining regrowth following the last menstruation. During this time, about once each month, an egg is released from one of the ovaries. That’s called ovulation. If the egg is not fertilized or an early embryo is not implanted in the prepared lining, then that “unused” uterine lining is shed—and a period is the result. A malfunction in any of the organs directly involved in stimulating ovulation (including signals from specific sites in the brain (the hypothalamus for instance), the anterior pituitary gland (which issues the required sequence and quantity of hormones to stimulate the ovary), and the ovary itself, can disrupt the process of ovulation.

“The most common cause of irregular periods in young women is polycystic ovary syndrome,” says Dr. Austin. Other causes of secondary amenorrhea, assuming the woman is not pregnant or going through menopause, are anorexia and excessive exercise, Dr. Kramer explains. “If a young woman is an elite gymnast before she starts menstruating, then menstruation may be delayed due to low body weight,” Dr. Austin says. “Even when they stop gymnastics, they may not get regular periods, so there is a real risk for young gymnasts.”

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Jenaca Beagley, MSN, APRN, NP-C, CDE, a nurse practitioner at Center for Change in Orem, Utah an eating disorder treatment facility says anorexia can also cause amenorrhea. “While the majority of underweight females will stop having a menstrual period as a direct result of malnutrition, some will not,” she explains. “Others who restrict calories but are still at what would be considered a ‘normal’ body weight, can stop having a monthly period as a symptom of starvation without being clinically underweight.”

The good news is, amenorrhea triggered by anorexia is usually a temporary condition. If a girl’s periods have stopped and the likely cause is anorexia, they should resume once she gains weight, Beagley says. “Eating disorders may induce different menstrual patterns, but in my experience after a patient starts to be consistent with nutrition and is at a healthy weight, periods usually return within 6 months,” she says. “If this does not happen patients are usually referred for further assessment and testing which may include checking hormone levels or ultrasound to look at the uterus and ovaries.”

Diagnosing Amenorrhea

Often the first step in reaching a diagnosis are simple blood tests that can rule out pregnancy as well as menopause, Dr. Kramer says.

Once these are ruled out, your health care provider will order tests to determine why you’re not ovulating.

One simple test is a progesterone withdrawal test, Dr. Kase explains. The female patient is given an orally-active dose of the ovarian hormone, progesterone. If she gets her period, that’s evidence her uterus is working, but she is not ovulating. “The ovaries are making estrogen but not ovulating,” Dr. Kase says. Next, tests are also done to see whether the pituitary gland is producing two vital hormones called follicle stimulating hormone (FSH) and luteinizing hormone (LH). “If levels of FSH are high, then something is likely wrong with the ovaries,” Dr. Kase says. “If they are low, then the ovaries are not getting the stimulation they need for ovulation to occur.” Imaging studies of the pituitary gland are then needed to clarify why the egg developing hormone FSH is not available and to identify the reason for this deficiency, he adds.

Treating Amenorrhea

The treatment for amenorrhea will depend on what is causing it, Dr. Kramer says. “Most commonly, it can be treated hormonally,” he says.

Treatment for polycystic ovary syndrome can vary, but a woman trying to get pregnant may be given medication to help her ovulate. If she is overweight, she may be told to lose weight.1

A woman who has a very low body weight will be told to increase her body fat, he says. In other words, she needs to gain weight. Treatment for anorexia may require inpatient care at a specialized facility which includes intensive therapy, nutrition education and medical care.

Medications may be necessary, and depending on the cause of the amenorrhea, other treatments may include surgery to remove ovarian cysts or uterine adhesions that might be causing the amenorrhea.

A woman who’s not getting her period and wants to get pregnant should consult with a gynecologist and possibly a reproductive endocrinologist. But women with amenorrhea should not assume they cannot conceive, Dr. Kramer says. “After a careful workup and evaluation to determine the cause of the amenorrhea, they will be given appropriate, cause-specific treatment,” he says.

Article Sources Last Updated: Sep 4, 2019

What Is Amenorrhea?

Find out about what causes amenorrhea, and how it can be treated.

Amenorrhea is the absence of menstrual bleeding in a woman of reproductive age.

There are two main types of amenorrhea:

Primary amenorrhea This is when a girl over age 15 has never had her period.

Secondary amenorrhea This is when a woman who has had regular periods stops having her period for six months or longer.

Natural changes in the body can cause your periods to stop.

For instance, women stop menstruating during pregnancy and breastfeeding.

There are many potential causes and risk factors for amenorrhea. Sometimes the cause is unknown.

Causes and risk factors for amenorrhea include:

  • Obesity
  • Having very low body fat (less than 15 to 17 percent body fat)
  • Deficiency of leptin, a hormone that regulates appetite
  • Polycystic ovarian syndrome (PCOS)
  • Overactive thyroid gland
  • Extreme emotional stress
  • Excessive exercise
  • Use of some contraceptives (it can take several months for periods to start again after stopping certain forms of birth control)
  • Certain medications (certain antidepressants and blood pressure medicines can increase levels of a hormone that prevents ovulation)
  • Chemotherapy and radiation treatments for cancer
  • Noncancerous pituitary tumor
  • Scar tissue in the uterus (uterine fibroids, a cesarean section, or certain abortion procedures can scar the uterus)

Other causes of hormonal problems that may lead to amenorrhea include:

  • Long-term illness, such as heart disease or cystic fibrosis
  • Genetic defects or disorders
  • Problems with the ovaries

Amenorrhea Symptoms

The major symptom of amenorrhea is the absence of periods.

You may experience additional symptoms depending on the cause of your amenorrhea.

Other symptoms may include:

  • Weight gain or weight loss
  • Changes in breast size, or milky discharge from the breast
  • Acne
  • Hair loss
  • Increased facial hair growth
  • Headaches or vision changes
  • Pelvic pain

Amenorrhea Diagnosis

There are a number of steps your doctor will take to determine whether you have amenorrhea.

First, your doctor will ask you about your symptoms to get a better picture of your medical history.

Your doctor may also perform a pelvic exam and do a pregnancy test to rule out the possibility of pregnancy.

Tests for amenorrhea may include:

  • Blood tests to check your hormone levels
  • Genetic testing
  • Pelvic ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI)

Amenorrhea Treatment

The treatment your doctor recommends will depend on the cause of your amenorrhea.

Treatments for amenorrhea may include medications, surgery, lifestyle changes, or a combination of these measures.

Lifestyle changes may include:

  • Taking steps to reach a healthy weight and maintain that weight (if you’re under- or overweight)
  • Interventions to reduce stress
  • If you’re an athlete, modifying the way you train or eat

Medical treatments for amenorrhea may include:

  • Hormonal medications, such as birth control pills
  • Estrogen replacement therapy
  • Medications for PCOS

Surgical treatments for amenorrhea may include:

  • Removal of scar tissue in the uterus
  • Removal of noncancerous pituitary tumor

Causes

Many things could cause amenorrhea.

Possible causes of primary amenorrhea (when a woman never gets her first period) include:

  • Failure of the ovaries
  • Problems in the central nervous system (brain and spinal cord) or the pituitary gland (a gland in the brain that makes the hormones involved in menstruation)
  • Problems with reproductive organs

In many cases, doctors don’t know why a girl never gets her first period.

Common causes of secondary amenorrhea (when a woman who has had normal periods stops getting them) include:

  • Pregnancy
  • Breastfeeding
  • Stopping the use of birth control
  • Menopause
  • Some birth control methods, such as Depo-Provera or certain types of intrauterine devices (IUDs)

Other causes of secondary amenorrhea include:

  • Stress
  • Poor nutrition
  • Depression
  • Certain prescription drugs
  • Extreme weight loss
  • Over-exercising
  • Ongoing illness
  • Sudden weight gain or being very overweight (obesity)
  • Hormonal imbalance due to polycystic ovarian syndrome (PCOS)
  • Thyroid gland disorders
  • Tumors on the ovaries or brain (rare)

A woman who has had her uterus or ovaries removed will also stop menstruating.

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