What is Amenorrhea? Causes, Symptoms and Treatment

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 idication 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.

Please note: It is not necessary to have all amenorrhea symptoms. Depending on the severity of the disease, you may experience a few or all of the symptoms.

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.

Following are some primary amenorrhea causes:

• Hereditary: A family history of delayed menstruation
• Genetic conditions: Certain genetic conditions such as:

1. Turner Syndrome (a chromosomal defect)
2. Mullerian defects (malformation of the reproductive organs)
3. Androgen sensitivity syndrome (leads to high levels of testosterone)

• Structural abnormality of the genitals or reproductive organs
• Hormonal issues due to problems with the hypothalamus or the pituitary gland

Menstruation may stop after it begins at puberty due to certain reasons. The following are secondary amenorrhea causes:

• 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:

1. Drugs for blood pressure
2. Allergy medications
3. Chemotherapy drugs for cancer
4. Antidepressants
5. 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:

1. 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.
2. Stress: Stress alters the functioning of the hypothalamus, which is responsible for controlling the hormone that regulates your menstrual cycle.
3. 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:

1. Thyroid malfunction: hypothyroidism or hyperthyroidism
2. Polycystic Ovarian Syndrome (PCOS): Causes relatively high and sustained levels of certain hormones.
3. Pituitary tumour: A benign tumour in the pituitary gland.
4. Premature menopause/ Primary ovarian insufficiency: When you experience menopause at the age of 40
5. Adrenal disorders
6. Hypothalamus disorders

• Surgery to remove ovaries or uterus
• Ovarian tumours

Amenorrhea treatment

Amenorrhea treatment depends on the type of amenorrhea.

Depending on the age, primary amenorrhea treatment may start with watchful waiting, especially if there’s a family history of late menstruation. Surgery can be done if there are any structural problems with the reproductive organs or genitals.

This, however, does not guarantee normal menstruation.

Since there are a number of secondary amenorrhea causes, secondary amenorrhea treatment depends on the underlying cause. If the period stops because of menopause or pregnancy, there is no need to be treated.

In other cases, the following are the treatment options:

• Losing weight through diet and exercise (if excess weight is the cause)
• Counselling and stress management techniques (if emotional and mental stress is the reason)
• Gaining weight through a professionally supervised weight gain regime (if too much weight loss is the cause)
• Change in exercise levels and patterns (if excessive exercise is the cause of disturbance in menstruation)
• Hormonal treatment (For some hormonal disorders such as thyroid, PCOS, etc)
• Surgery (Only in rare cases)

To treat some side effects of secondary amenorrhea, your doctor may prescribe the following treatments:

• Estrogen therapy to prevent vaginal dryness and provide relief in hot flashes
• Strength training
• Vitamin D and calcium supplements for strong bones

Conclusion

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, amenorrhea treatment is required at the earliest.

Primary and secondary amenorrhea can both be treated and managed well at Birla IVF & Fertility. The doctors here are well-qualified and empathetic and consider the health of the patient as their topmost priority. Besides, the department is equipped with state-of-the-art facilities to treat your problems effectively and quickly.

Visit Birla Fertility & IVF and book an appointment with Dr. Rachita Munjal for the best amenorrhea treatment.

Frequently asked questions (FAQs)

1. What medications treat amenorrhea?

Birth control pills are provided for amenorrhea treatment. Iron supplements, multivitamins, calcium, etc., are also given to treat amenorrhea.

2. 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.

3. How can I get my periods back from amenorrhea?

Consulting your healthcare provider is a must, as there are a number of amenorrhea causes. Proper diagnosis and treatment are required to bring your periods back.

4. What is the main cause of amenorrhea?

Pregnancy is the most common secondary amenorrhea cause. Although, problems with hormones are also a major cause.