Missing one or more menstrual periods is defined as amenorrhea.
- If you haven’t gotten your first period by the age of 15, it is known as primary amenorrhea.
- On the other hand, the absence of three or more periods in a row by someone who has had periods before is termed secondary amenorrhea. It is basically the omission of menstruation in women of reproductive age.
Though the causes vary from person to person, the most common cause is hormonal imbalance. It is a treatable condition, and the treatment depends on the cause.
Amenorrhea Symptoms
Though lack of menstruation is the main amenorrhea symptom, there are other symptoms that can be an indication too. These are:
- Pain in the pelvis
- Loss of hair
- Headaches
- Acne
- Changes in the vision
- Excess growth of hair on the face and body
- Hot flashes
- Milky discharge from the nipples
- Nausea
- Changes in the size of the breast
- In primary amenorrhea, there may be a lack of breast development.
Amenorrhea Types
There are two types of amenorrhea. They can be classified as primary and secondary amenorrhea.
Primary Amenorrhea
When a girl does not get a period by the age of 15-16 or within five years after she reaches puberty, it is known as primary amenorrhea.
This happens due to changes in the organs, hormones, and glands responsible for or related to menstruation.
Secondary Amenorrhea
Secondary amenorrhea is considered when you have had regular periods in the past but haven’t had any for at least three months. It is also considered if you have had irregular periods in the past but haven’t had any for six months or more.
This may happen due to stress, some illness, or pregnancy.
Amenorrhea Causes
Amenorrhea causes differ based on the types of amenorrhea.
Causes of primary amenorrhea:
- Hereditary: A family history of delayed menstruation
- Genetic conditions: Certain genetic conditions such as:
-
- Turner Syndrome (a chromosomal defect)
- Mullerian defects (malformation of the reproductive organs)
- Androgen sensitivity syndrome (leads to high levels of testosterone)
- Structural abnormality of the genitals or reproductive organs.
- Hormonal issues: These can be due to problems with the hypothalamus or the pituitary gland
Causes of secondary amenorrhea:
- Pregnancy
- Breastfeeding
- Menopause
- Oral contraceptive pills (OCPs): Occasionally, regular ovulation and menstruation may take some time to return even after OCPs are stopped.
- Certain Intra-uterine Devices (IUDs)
- Medications: Certain medications can also cause amenorrhea, such as:
-
- Drugs for blood pressure
- Allergy medications
- Chemotherapy drugs for cancer
- Antidepressants
- Antipsychotics
- Radiation therapy for cancer
- Uterine scarring: In this, scar tissue builds up in the inner lining of the uterus. This sometimes happens after a dilation and curettage (D&C), caesarean section, or treatment for uterine fibroids. This prevents the normal buildup and shedding of the uterine lining, disrupting menstruation.
- Lifestyle factors: A number of lifestyle factors are responsible for secondary amenorrhea. They are:
-
- Low body weight: Serious weight loss, typically with a body mass index (BMI) of less than 19, can cause ovulation and hence menstruation to stop.
- Stress: Stress alters the functioning of the hypothalamus, which is responsible for controlling the hormone that regulates your menstrual cycle.
- Too much exercise: Rigorous exercise leads to low body fat, stress, and high energy expenditure and results in disturbed menstrual cycles.
- Hormonal disorders: Some hormonal disorders can also lead to secondary amenorrhea, such as:
-
- Thyroid malfunction: hypothyroidism or hyperthyroidism
- Polycystic Ovarian Syndrome (PCOS): Causes relatively high and sustained levels of certain hormones.
- Pituitary tumour: A benign tumour in the pituitary gland.
- Premature menopause/ Primary ovarian insufficiency: When you experience menopause at the age of 40
- Adrenal disorders
- Hypothalamus disorders
- Surgery to remove ovaries or uterus
- Ovarian tumours
Diagnosis of Amenorrhea
To determine the underlying cause of the absence of menstrual cycles, a thorough medical evaluation is required for the diagnosis of amenorrhea. The steps in the amenorrhea diagnosis generally include:
Medical History:
The first step in diagnosis involves reviewing the medical record of the patient and getting a thorough medical history from the patient. This will include details like:
- The patient’s menstrual history,
- The age at which puberty began,
- Previous menstrual patterns,
- Any recent changes to their weight or exercise routines,
- the presence of any other symptoms or medical conditions
Physical Examination:
A thorough physical assessment will be performed by an expert to determine the patient’s overall health, including:
- Body weight,
- The distribution of body fat,
- Any abnormal findings in the pelvic area
- any indicators of androgen excess (such as excessive hair growth)
Evaluation of Hormones:
Blood tests will be done to determine hormone levels, including:
- Elevated follicle-stimulating hormone (FSH) levels may be a sign of menopause or primary ovarian failure.
- Luteinizing hormone (LH) levels that are out of the ordinary can shed light on ovulation and hormonal abnormalities.
- Thyroid hormones: Since amenorrhea can be caused by thyroid dysfunction, thyroid hormone levels (TSH, T3, and T4) will be examined.
Prolactin:
It will be evaluated since high prolactin levels can cause amenorrhea.
Imaging investigations: Imaging tests may generally be carried out to see the reproductive organs and find any structural abnormalities in the body, specifically in the pelvis region. This may consist of:
- Ultrasound: To check for any anomalies in the uterus, ovaries, and other pelvic organs.
- MRI or CT scan: These imaging procedures can offer more in-depth knowledge about the genitalia and the pituitary gland, which is essential in controlling menstruation.
Tests for Ovarian reserve:
Diagnostic tests to evaluate ovarian reserve, such as the antral follicle count and anti-Müllerian hormone (AMH) levels, may be performed on women suspected of experiencing premature ovarian failure.
Progestin Challenge Test:
A progestin challenge test may be carried out when the reason for amenorrhea is uncertain. This entails taking progestin medicine for a few days and then keeping an eye out for withdrawal bleeding, which can show healthy oestrogen levels and an intact uterus.
Genetic screening:
It is usually advised in some circumstances to look for any chromosomal or genetic anomalies connected to amenorrhea.
Amenorrhea Treatment
After a thorough diagnosis of the condition, amenorrhea treatment options can range from hormonal medications to surgical techniques, depending on the underlying cause. The expert will determine the technique for effective results after amenorrhea treatment. Some of the amenorrhea treatment methods include:
Hormonal Therapies:
- Birth control: Combination oral contraceptives are frequently administered to women whose amenorrhea is brought on by hormonal abnormalities, such as polycystic ovary syndrome (PCOS) or dysfunction of the hypothalamus. Oral contraceptives that include oestrogen and progestin can control hormone levels and trigger regular menstrual cycles.
- Progestin Therapy: In some situations, women with secondary amenorrhea brought on by anovulation or irregular cycles may be offered progestin-only drugs to encourage uterine lining shedding and initiate monthly flow.
Hormone Replacement Treatment (HRT):
HRT may be advised for women who experience primary or secondary amenorrhea due to menopause or early ovarian failure. In HRT, oestrogen and progesterone are given to imitate the hormonal balance that prevails during the reproductive years.
Medication:
The expert may advise a few medications and fertility drugs to stimulate the ovaries for normal function.
Some of the common fertility drugs that are generally advised during amenorrhea treatment are:
- Clomiphene Citrate, which is frequently prescribed to women with amenorrhea brought on by PCOS or other ovulatory problems, The hormones that cause ovulation are stimulated to release when clomiphene citrate is taken.
- Human Chorionic Gonadotropin(hCG): In some instances, women who do not respond to clomiphene citrate or who have other fertility concerns use hCG injections to trigger ovulation.
Surgical Procedures:
In some cases, an expert may advise surgical intervention based on the severity of the condition. Some of the surgical techniques involve:
- Ovarian drilling: It is an alternative method for surgical treatment advised to patients with PCOS in order to control insulin resistance. This helps in lowering the levels of androgen (male hormone) production and increases ovulation, tiny holes are created in the ovaries using heat or lasers.
- Uterine Surgery: Amenorrhea may be brought on by structural issues with the uterus, such as uterine adhesions or fibroids. Surgery can be used in these situations to resolve these problems and restore menstrual function.
Changes in Lifestyle:
During the minor stage, the doctor will recommend some lifestyle modifications in order to increase the quality of life and to improve the symptoms of amenorrhea:
- Weight Management: Hormonal balance depends on maintaining a healthy weight. Gaining weight or cutting back on strenuous exercise may help restore regular menstrual periods in women who have amenorrhea as a result of excessive exercise or low body weight.
- Stress management: Excessive stress might interfere with the hormonal system that regulates menstruation. For women with amenorrhea brought on by stress-related issues, stress reduction treatments like meditation, yoga, or counselling may be helpful.
Psychological Support:
Amenorrhea condition can also be influenced by emotional and psychological factors. Therapy or counselling may be helpful for some women in resolving emotional problems associated with amenorrhea and fostering a positive outlook.
Takeaway
To identify the underlying cause and create a suitable treatment plan, it is imperative for women who are experiencing amenorrhea to speak with an expert specialist for effective and suitable treatment. Though amenorrhea is not life-threatening, it can lead to increased risks and complications over time. It can lead to infertility, cause problems with pregnancy, cardiovascular diseases, and osteoporosis. It can also cause psychological stress, especially in adolescence, since it is a transitioning age. Hence, early intervention is required to manage the condition before any further complication arises.
If you are struggling with primary or secondary amenorrhea, feel free to reach out to our healthcare experts at Birla IVF & Fertility. Our doctors are well-qualified and address the issues of the patient with empathy.
FAQs:
What Medications Treat Amenorrhea?
Birth control pills are provided for amenorrhea treatment. Iron supplements, multivitamins, calcium, etc., are also given to treat amenorrhea.
What is the First Line of Treatment for Amenorrhea?
Hormonal medications are the mainstay of amenorrhea treatment. However, additional medications may be needed to treat the underlying cause.
How Can I Get My Periods Back From Amenorrhea?
Consulting your healthcare provider is a must, as there are multiple causes of amenorrhea. Proper diagnosis and treatment are required to bring your periods back.
What is the Main Cause of Amenorrhea?
Pregnancy is the most common secondary amenorrhea cause. Although, problems with hormones are also a major cause.