What is Amenorrhea?

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When a woman is not bleeding or having her menstrual cycle it is called amenorrhea. This often occurs when a woman skips one or two of her menstrual cycles. There are different types of amenorrhea. Primary amenorrhea refers to someone who has not had a period before the age of 15. Secondary amenorrhea refers to someone not getting their period for two or three months in a row. There are different factors which can cause amenorrhea, such as pregnancy, menopause, and other anatomical problems. Amenorrhea is not a disease but might be a symptom of an underlying condition such as hormonal, genetic, and structural disorders. 


Natural Causes of Amenorrhea

Amenorrhea can occur for different reasons. During your life, you might experience amenorrhea due to pregnancy, breastfeeding, and menopause. Hormonal imbalance can lead to amenorrhea. Many different medical conditions can cause a hormonal imbalance such as polycystic ovarian syndrome (PCOS), thyroid malfunction, a pituitary tumour and premature menopause. Most hormone imbalances are due to fluctuating hormones, PCOS keeps hormone levels higher than normal. Thyroid malfunction can cause menstrual irregularities. Menopause usually start at the age of 50 but for some women, it already starts at the age of 40, this is called premature menopause, causing hormonal fluctuations. 


Lifestyle Factors Causing Amenorrhea 

Some lifestyle factors can cause amenorrhea. These factors include low body weight, excessive exercise, and stress. Excessive low body weight can contribute to fluctuating hormones. Normally it is associated with ovulation that stops. Women who struggle with anorexia and bulimia often get amenorrhea because of inconsistent hormone levels. Women who are involved with difficult training such as ballet, may experience interrupted menstrual cycles. Other factors can also contribute to amenorrhea in athletes such as low body fat, stress, and high energy expenditure. Stress can harm the function of the hypothalamus; this is the part of the brain responsible for regulating hormones. Ovulation and menstruation might stop during this stressful time, but it can return to normal once you reduce your stress levels. 


Complications of Amenorrhea

Amenorrhea can cause serious complications if not treated properly. These complications include:

  • Infertility Problems and struggling to fall pregnant – ovulation does not occur during amenorrhea. If there is no ovulation, there will be no egg cells to fertilise. If you are pregnant, hormone imbalances with amenorrhea can also increase the chances of a miscarriage.

  • Psycological Stress – it can be a stressful experience for girls not getting their period when all their friends are getting theirs. This can cause psychological stress.

  • Osteoporosis and Cardiovascular Disease – When your body is not producing enough oestrogen, osteoporosis and cardiovascular diseases are a major risk. This is especially a risk for women who are in menopause. Osteoporosis is when your bone density decreases, and you are more prone to bone fracture and breaking your bones. Cardiovascular heart diseases include heart attacks and stroke.

  • Pelvic Pain – You may experience pelvic pain, should an anatomical problem be the cause of your amenorrhea.


How is Amenorrhea Diagnosed?

If you are sexually active and missing your period, it is advised that you first take a pregnancy test. If you are not pregnant and still missing your period, your doctor will order the following tests, imaging, bloods, hysteroscopy, genetic screening, and chromosome evaluation. Imaging tests such as MRI scans, CT scans and ultrasounds can be used to examine the pelvis area for any abnormal growth and can also indicate if there are any birth defects blocking your menstrual flow. Blood tests are done to measure hormone levels and check for any fluctuations or imbalances.

Hysteroscopy is a procedure done in a hospital where the doctor will send a thin, lighted camera through your vagina into your uterus to examine for any abnormalities. During genetic screening the doctor will look for any changes in your FMR1 gene, this can disrupt your ovaries from functioning properly and lead to amenorrhea. The doctor might also look for a condition called Turner’s syndrome, in which there is an abnormality on your X chromosome, this can lead to primary amenorrhea. 


Treatment for Amenorrhea

Treatment for amenorrhea will focus on addressing the underlying disorder causing it. If amenorrhea is caused by a physical abnormality blocking menstrual flow, then surgery will be recommended. Primary amenorrhea can be the result of Swyer syndrome, this condition increases the risk for gonadal cancer. Treatment involves removing the gonads surgically. Other conditions such as Turner’s syndrome will involve taking hormone replacement therapy. 

Medical treatments for secondary amenorrhea:

  • Oral contraceptives
  • For women with PCOS, medication will be prescribed to help induce ovulation
  • Oestrogen replacement therapy can help with hormonal imbalances and help women with primary ovarian insufficiency and help restart their menstrual cycle. 
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