About amenorrhea

What is amenorrhea?

Amenorrhea facts

  • Amenorrhea refers to the absence of menstrual periods; it may be either primary (meaning a woman never developed menstrual periods) or secondary (absence of menstrual periods in a woman who was previously menstruating).
  • Genetic or inborn conditions are the most common causes of primary amenorrhea.
  • Amenorrhea may result from disorders of the ovaries, pituitary gland, or hypothalamus.
  • Intensive exercising, extreme weight loss, physical illness, and stress can all result in amenorrhea.
  • Amenorrhea is a symptom and not a disease in itself, so amenorrhea can be prevented only to the extent that the underlying cause can be prevented.
  • Infertility and bone loss (osteoporosis) are complications of amenorrhea.
  • Treatments may include surgical correction of anatomical abnormalities, medications or hormone therapies, and treatment of any underlying conditions responsible for amenorrhea.
  • The outlook for amenorrhea varies according to the cause of the amenorrhea.

What is amenorrhea?

Amenorrhea is the medical term for the absence of menstrual periods, either on a permanent or temporary basis. Amenorrhea can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.

The menstrual cycle can be influenced by many internal factors such as transient changes in hormonal levels, stress, and illness, as well as external or environmental factors. Missing one menstrual period is rarely a sign of a serious problem or an underlying medical condition, but amenorrhea of longer duration may signal the presence of a disease or chronic condition.



What are the symptoms for amenorrhea?

The main sign of Amenorrhea is the absence of menstrual periods. Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as:

  • Milky nipple discharge
  • Hair loss
  • Headache
  • Vision changes
  • Excess facial hair
  • Pelvic pain
  • Acne

When to see a doctor

Consult your doctor if you've missed at least three menstrual periods in a row, or if you've never had a menstrual period and you're age 15 or older.



What are the causes for amenorrhea?

Amenorrhea can occur for a variety of reasons. Some are normal during the course of a woman's life, while others may be a side effect of medication or a sign of a medical problem.

Natural amenorrhea

During the normal course of your life, you may experience amenorrhea for natural reasons, such as:

  • Pregnancy
  • Breast-feeding
  • Menopause

Contraceptives

Some women who take birth control pills may not have periods. Even after stopping oral contraceptives, it may take some time before regular ovulation and menstruation return. Contraceptives that are injected or implanted also may cause amenorrhea, as can some types of intrauterine devices.

Medications

Certain medications can cause menstrual periods to stop, including some types of:

  • Antipsychotics
  • Cancer chemotherapy
  • Antidepressants
  • Blood pressure drugs
  • Allergy medications

Lifestyle factors

Sometimes lifestyle factors contribute to amenorrhea, for instance:

  • Low body weight. Excessively low body weight — about 10 percent under normal weight — interrupts many hormonal functions in your body, potentially halting ovulation. Women who have an eating disorder, such as anorexia or bulimia, often stop having periods because of these abnormal hormonal changes.
  • Excessive exercise. Women who participate in activities that require rigorous training, such as ballet, may find their menstrual cycles interrupted. Several factors combine to contribute to the loss of periods in athletes, including low body fat, stress and high energy expenditure.
  • Stress. Mental stress can temporarily alter the functioning of your hypothalamus — an area of your brain that controls the hormones that regulate your menstrual cycle. Ovulation and menstruation may stop as a result. Regular menstrual periods usually resume after your stress decreases.

Hormonal imbalance

Many types of medical problems can cause hormonal imbalance, including:

  • Polycystic ovary syndrome (PCOS). PCOS causes relatively high and sustained levels of hormones, rather than the fluctuating levels seen in the normal menstrual cycle.
  • Thyroid malfunction. An overactive thyroid gland (hyperthyroidism) or underactive thyroid gland (hypothyroidism) can cause menstrual irregularities, including amenorrhea.
  • Pituitary tumor. A noncancerous (benign) tumor in your pituitary gland can interfere with the hormonal regulation of menstruation.
  • Premature menopause. Menopause usually begins around age 50. But, for some women, the ovarian supply of eggs diminishes before age 40, and menstruation stops.

Structural problems

Problems with the sexual organs themselves also can cause amenorrhea. Examples include:

  • Uterine scarring. Asherman's syndrome, a condition in which scar tissue builds up in the lining of the uterus, can sometimes occur after a dilation and curettage (D&C), cesarean section or treatment for uterine fibroids. Uterine scarring prevents the normal buildup and shedding of the uterine lining.
  • Lack of reproductive organs. Sometimes problems arise during fetal development that lead to a girl being born without some major part of her reproductive system, such as her uterus, cervix or vagina. Because her reproductive system didn't develop normally, she can't have menstrual cycles.
  • Structural abnormality of the vagina. An obstruction of the vagina may prevent visible menstrual bleeding. A membrane or wall may be present in the vagina that blocks the outflow of blood from the uterus and cervix.



What are the treatments for amenorrhea?

Treatment of primary and secondary amenorrhea is determined by the specific cause. Treatment goals can be to relieve symptoms of hormonal imbalance, establish menstruation, prevent complications, and/or to achieve fertility, although not all of these goals can be achieved in every case.

In cases in which genetic or anatomical abnormalities are the cause of amenorrhea (typically primary amenorrhea), surgery may be recommended.

Hypothalamic amenorrhea that is related to weight loss, excessive exercise, physical illness, or emotional stress can typically be corrected by addressing the underlying cause. For example, weight gain and reduction in intensity of exercise can usually restore menstrual periods in women who have developed amenorrhea due to weight loss or overly intensive exercise who do not have additional causes of amenorrhea. In some cases, nutritional counseling may be of benefit.

In premature ovarian failure, hormone therapy may be recommended both to avoid the unpleasant symptoms of estrogen depletion as well as prevent complications (see below) of low estrogen level such as osteoporosis. This may consist of oral contraceptive pills for those women who do not desire pregnancy or alternative estrogen and progesterone medications. While postmenopausal hormone therapy has been associated with certain health risks in older women, younger women with premature ovarian failure can benefit from this therapy to prevent bone loss.

Women with PCOS (polycystic ovary syndrome) may benefit from treatments that reduce the level or activity of male hormones, or androgens.

Dopamine agonist medications such as bromocriptine (Parlodel) can reduce elevated prolactin levels, which may be responsible for amenorrhea. Consequently, medication levels may be adjusted by the person's physician if appropriate.

Assisted reproductive technologies and the administration of gonadotropin medications (drugs that stimulate follicle maturation in the ovaries) can be appropriate for women with some types of amenorrhea who wish to attempt to become pregnant.

While many companies and individuals have marketed herbal therapies as a treatment for amenorrhea, none of these have been conclusively proved to be of benefit. These therapies are not regulated by the U.S. FDA and the quality of herbal preparations is not tested. Herbal remedies have been associated with serious and even fatal side effects in rare cases, and some preparations have been shown to contain high levels of toxins. Before deciding to take a natural or alternative remedy for amenorrhea, it is wise to seek the advice of your health care practitioner.



What are the risk factors for amenorrhea?

Factors that may increase your risk of amenorrhea may include:

  • Family history. If other women in your family have experienced amenorrhea, you may have inherited a predisposition for the problem.
  • Eating disorders. If you have an eating disorder, such as anorexia or bulimia, you are at higher risk of developing amenorrhea.
  • Athletic training. Rigorous athletic training can increase your risk of amenorrhea.



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