Amenorrhea: Absence of Menstruation

Amenorrhea is the absence of menstrual period in a woman of reproductive age. It can be conventionally divided into primary and secondary amenorrhea. Primary amenorrhea refers to no menstrual periods by age 16. Secondary amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for 3 or more months in the absence of pregnancy, lactation (breastfeeding), cycle suppression with systemic hormonal contraceptive (birth control) pills, or menopause. Amenorrhea has been associated with reduced bone density and increased fracture rates.

A symptom, not a disease, amenorrhea seldom results from a serious condition. Physiological states of amenorrhoea are seen during pregnancy and lactation (breastfeeding). Physiologic in the sense that it is completely normal and is not caused by anything medically harmful. Besides pregnancy and lactation, there are many other possible explanations for amenorrhea.

What are the symptoms of amenorrhea?

Amenorrhea itself is not a disease, but is usually a symptom of another condition. The main indication of amenorrhea is missing a menstrual period. Missing a period may mean that you are pregnant or that something is going wrong. Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as galactorrhea (breasts produce milk in a woman who is not pregnant or breastfeeding), headache, reduced peripheral vision, or increased hair growth on your face and torso (hirsutism) caused by excess androgen.

What are the causes of amenorrhea?

Amenorrhea is a symptom of several factors, ranging from not serious to serious.

• Primary Amenorrhea:
  • Certain chromosomal or genetic abnormalities can cause the eggs and follicles involved in menstruation to deplete too early in life.
  • A pituitary gland (gland in the brain that's involved in regulating the menstrual cycle) disease or problem with the hypothalamus (an area at the base of the brain that acts as a control center for the body and regulates menstrual cycle) can prevent periods from starting.
  • Excessive exercise, eating disorders (such as anorexia), extreme physical or psychological stress, or a combination of these can disrupt the normal menstrual cycle.
  • Physical problems such as problems with reproductive organs can prevent periods from starting.
• Secondary amenorrhea: Secondary amenorrhea is more common than primary amenorrhea.
  • Common causes include many of those listed for primary amenorrhea as well as pregnancy, lactation (breastfeeding), mental stress and contraceptives (birth control pills).
  • Certain medications like antidepressants, antipsychotics and some chemotherapy drugs can cause menstrual periods to stop.
  • A common cause of amenorrhea or irregular periods is polycystic ovary syndrome (PCOS). This condition causes relatively high and sustained levels of estrogen and androgen (a male hormone) rather than the fluctuating levels seen in the normal menstrual cycle which results in a decrease in the pituitary hormones that lead to menstruation and ovulation. PCOS is associated with obesity, acne, sometimes excess facial hair and amenorrhea or abnormal, often heavy, uterine bleeding.
  • Very low body weight interrupts many hormonal functions in the body, potentially halting ovulation.
  • Menopause usually occurs between ages 45 and 55. In some women, the ovarian supply of eggs diminishes before age 40, a condition known as primary ovarian insufficiency. Primary ovarian insufficiency, also referred to as premature menopause, may result from genetic factors or autoimmune disease, but often no cause can be found.
  • An underactive thyroid gland (hypothyroidism) commonly causes menstrual irregularities, including amenorrhea.

What is the treatment for amenorrhea?

Treatment depends on the underlying cause of the missing period. Lifestyle changes can help if weight, stress, or physical activity is the cause of amenorrhea. Primary amenorrhea caused by birth defects may require medications (hormones), surgery, or both. In case of PCOS or hypothalamic amenorrhea, doctor may prescribe oral contraceptives to treat the problem. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications.

In most cases, amenorrhea is not a life-threatening condition. The best way to avoid an interruption in your menstrual cycle is to maintain a healthy lifestyle. Be aware of changes in your menstrual cycle and check with your doctor if you have concerns.