The World of Pregnancy

Amenorrhea: Symptoms, Causes, Diagnosis & Treatment

Amenorrhea (lack of menstruation) can occur both during puberty as well as later when you are sexual active.

About Amenorrhea

Primary amenorrhea refers to a lack of menstruation until the age of 16 (if there wasn`t any menstrual cycle up to this age). On the other hand, secondary amenorrhea is the absence of menstruation given that menstrual cycles already happened. Of course, the first thing at you should think when referring to secondary amenorrhea is pregnancy, although there are several other reasons which such delays may occur, such as disorders of menstrual cycles.

This particular symptom should not be seen as a disease, but rather as a disorder that rarely represents the manifestation of any disease. Anyway, ignoring the cause of a menstruation delay can represent a reason of concern that is most of the times unjustified.  With the help of a few investigations and a discussion with a doctor, any cause for your lack of menstruation can be detected right away and appropriate measures be taken.

Symptoms

Lack of menstruation indicates that amenorrhea was installed. There`s a difference in terms of primary and secondary amenorrhea.

As mentioned above, we talk about primary amenorrhea when there wasn`t any menstrual cycle until the age of 16 years old. When there are no menstrual cycles for 3 – 6 months or even more but there were previous menstrual cycles, we talk about secondary amenorrhea.

Depending on the cause this disorder, there are other symptoms that can be noticed: lactation, headache, emotional disorders, hair loss or excessive facial hair growth.

Causes

There are many causes that can lead you to believe that you experience primary or secondary amenorrhea.

Primary Amenorrhea

It`s considered that this type of amenorrhea affects at least 1 out of 1,000 young girls. The most frequent causes are:

  • Chromosome abnormalities – structural abnormalities can lead to a premature loss of eggs and follicles involved in ovulation and menstruation.
  • Disorders of the hormone secretion of the hypothalamus – in case of amenorrhea of hypothalamic origin we confront with a disorder of secretion of endocrine hormones, the endocrine gland located at the base of the brain in the bone structure of the sphenoid bone, known as Turkish saddle, with a role in regulating the entire endocrine system of some essential body functions as well as with possible implications in the regulating menstrual cycle. Intense physical exercise or eating disorders, such as anorexia nervosa and excessive psychological stress, can all contribute to a disruption of the hypothalamic normal function. Hypothalamic tumors, to a lesser extent, cause disruptions of menstrual cycle.
  • Disorders of the pituitary gland – the pituitary gland is an endocrine gland located at the base on the brain and can affect by the proper function of menstrual cycles.
  • Lack or incomplete development of some organs of the female reproductive system – certain problems can occur during fetal period and embryonic development of the sexual organs, cases in which certain parts or organs may be missing: for instance, the uterus, cervix or vagina. In any of these cases, menstrual cycles won`t be able to be produced due to incomplete development.
  • Structural abnormalities of the vagina – these can prevent normal menstrual cycles. The presence of some developed membrane structures from the uterine wall, and which obscure the vaginal, can block the endometrial blood flow from the menstrual periods.

Secondary Amenorrhea

Secondary amenorrhea is a lot more frequent than the primary one. There are also much more causes for this type of amenorrhea.

  • Pregnancy – this can be the most frequent cause for women in the reproductive period. When the egg is fertilized and is implanted in the uterine mucosa (endometrium), there won`t be any menstrual cycles, the endometrium suffering transformations to feed the developing egg and to form the placenta, the egg not being eliminated through menstruation.
  • Contraceptives – some women who use birth control pills can experience some menstrual cycle disorders. It can pass between 3 and 6 months when stopping contraceptives until restoring regulate menstrual cycles as well as a normal ovulation.
  • Breastfeeding – new mothers who are breastfeeding can experience secondary amenorrhea. Even in the cases when ovulation occurs, menstruation can still be absent. In these cases, it will be harder to find a possible pregnancy as it won`t be visible through amenorrhea.
  • Stress – mental stress can temporarily alter the normal function of the hypothalamus – the neurological structure with a role in regulating and controlling the entire endocrine system, of hormonal secretions of the glands and implicitly of the menstrual cycle. Consequently, ovulation and menstruation may stop due to a mental stress, while normal cycles will be resumed after the period in question has passed.
  • Medications – there`s a certainty that a series of medications may alter the menstrual cycle. From all of them, we can mention: antidepressants, antipsychotics, anti-cancer chemotherapy, corticosteroids, etc.
  • Chronic diseases – the installation of amenorrhea in severe chronic diseases is already known. In some cases, this symptom can occur at the beginning of the disease. Menstrual cycles will reinstall after proper treatment and recovery.
  • Hormonal balance – a common cause of irregular menstrual cycles is polycystic ovary syndrome. It will be recorded relatively high and sustained levels of sexual hormones (estrogens and androgens) in the case of this syndrome, a normal hormonal fluctuation of the menstrual cycle being harder to be realized. Lots of times, the polycystic ovary is associated with obesity, abundant uterine bleeding during periods, acne, excessive facial hair growth, besides normal classic disorders.
  • Low body weight – a body weight that is too small can be followed by the interruption of normal synthesis of several hormones due to ovulation and menstruation being affected. Women who have severe eating disorders, found in syndromes such as anorexia or bulimia, may experience abnormal changes in the endocrine system with menstrual cycle disorders.
  • Excessive physical effortdisruption of menstrual cycles with secondary amenorrhea can be encountered at athletes especially during intense training (training camps and competitions). The sports in which these problems are frequently encountered are: athletics (especially marathon), gymnastics, ballet, etc. But it should be specified that there are several factors in the case of athletes that are involved in menstrual cycle disorders, namely: the low amount of body fat, stress, high energy consumption, etc.
  • Disturbances in the normal functionality of the thyroid gland – thyroid diseases are frequently involved in impaired menstrual cycles. The fact that the thyroid gland will be affected will generate a decrease of prolactin – the hormone secreted by the pituitary gland with a role in regulating the milk secretion and mammary gland development – an effect that will have consequences on the hypothalamic function and which will affect menstrual cycles.
  • Pituitary tumors – benign tumors of the endocrine glands, such as adenomas or prolactinoma, may cause exaggerated prolactin secretion which can interact with regular secretion of hormones involved in regulating the menstrual cycle. Some of these tumors can be treated by drug administration in a distinct category and requires surgery.
  • Uterine lesions conditions in which in the uterus may exist structures that prevent menstrual blood elimination during period – they can be the causes of amenorrhea. Some of the disease or interventions which can cause lesions are: uterine fibroids, curettages, C-sections, etc. As a result of these setbacks in the normal evaluation of the uterine contents to menstrual cycles, these will have either an abnormal aspect when the blood will drain after a period of stagnation in the uterus, or amenorrhea will install in the situation of a complete obstruction.
  • Premature menopause – menopause is generally installed at an average age of 51 years. If it`s installed before 40 years, it`s called premature menopause. Lack of hormone synthesis function of the ovaries will be associated with a decreased circulation of the estrogen hormones as well as due to thickening cycles and desquamation of the endometrium (uterine lining) with direct implication on menses. Premature menstruation can be the result of genetic factors, autoimmune diseases, but also of unknown origin.

You will need to contact your doctor for an examination in the following cases:

  • You haven`t had any menstrual cycle yet and you are over 16 years old – primary amenorrhea.
  • When the menstrual cycle is absent for 2 or more consecutive months – secondary amenorrhea.

Diagnosis

Although this disorder can rarely represent a serious health problem, it can sometimes represent a sign of alarm for a series of hormonal disorders. Their discovery might take a lot of time and may require lots of laboratory tests.

The first test that will be recommended by the doctor (if you won`t do it on your won at home before visiting a doctor) is the pregnancy test. The doctor will perform a gynecological examination through which will evaluate if there`s a possible pregnancy involved as well as the female genital state with any pathological elements that could form the basis of this disorder.

The next step is represented by the blood tests which will determine the level of several hormones. It will be made an assessment of the thyroid hormone through the circulating level of its hormones (thyroxine and triiodothyronine), of prolactin, etc. It will also be made a progesterone challenge test.

Depending on the signs and symptoms associated with the results of the laboratory tests, it will be established whether if there are other tests necessary. Other type of investigations, such as computed tomography, ultrasound, magnetic resonance, may highlight any pituitary tumors, female genital abnormalities, etc.

As a last resort, you may need to do a laparoscopy or mini-invasive hysteroscopy, which are invasive methods of examinations of the sexual organs that allow the doctor a direct exploration.amenorrhea

Treatment

The type of treatment that you need will be established by the disorder`s causes. In some cases a recommendation of the doctor to change certain aspects in your lifestyle is enough, such as physical activity (intense effort, body weight, etc) or physical (excessive stress).

In the case of certain trigger diseases, such as polycystic ovary generators or even athletic amenorrhea, the doctor can recommend birth control pills which will resolve the problem by hormonal excess and the rhythm of their administration.

Amenorrhea caused by diseases of the endocrine gland, such as the thyroid or pituitary glands, will be resolved once the main disease will be treated.

To Remember!

The best way to avoid the interruption of menstrual cycles is maintaining a healthy lifestyle by doing some specific things differently such as:

  • Make certain changes in your diet, physical activity, body weight.
  • Try to have a optimal balance between work and rest.
  • Evaluate the moments of depression, stress and conflict from your life. If you aren`t able to reduce these phenomenon, ask for help from your family, friends or doctor.
  • Be vigilant regarding menstrual cycles and get in touch with your doctor when you have reasons for concern. Keep track of your menstrual cycles and even note them down to know when to expect your next cycle.
  • Talk with your mother, sister and other women from your group of friends. Any of these persons can have similar issues and may clarify certain aspects for you. However, this doesn`t need to stop you from visiting your doctor.
  • Collect any information you think your doctor may find it useful in the event of a consultation.
  • Amenorrhea can be a cause for anxiety, but only if you collaborate with your doctor can find its cause and establish together how it`s best to regulate your menstruation cycles.
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