What is Amenorrhea: Causes, Symptoms, and Treatment

Defined in very simple words, amenorrhea is the absence of a menstrual period in a woman during her reproductive age. Normal menstruation starts at the age of 12, but the range can vary. Amenorrhea may exist when a woman does not experience periods for three months in a row or her first period by the age of 16. Not having menstrual cycles is not a disease in itself, rather it is a symptom of an underlying medical condition which can be treated by seeking proper health care.

What is Amenorrhea?

For a woman to have regular menstrual periods, it is necessary that her pituitary glands, ovaries, hypothalamus, and uterus function properly. Pituitary glands, on the stimulation of the hypothalamus, release FSH and LH hormones which cause the ovaries to produce estrogen and progesterone. The latter are responsible for the cyclic changes in the uterine lining including menstruation.

A woman can have the absence of menstrual cycles for the following reasons: if she has not reached puberty, if she is pregnant, or if she has reached menopause. But if the condition arises in cases other than the ones mentioned, especially if she misses at least three menstrual periods in a row, it is important to consult a doctor immediately.

Amenorrhea: Types and causes

Amenorrhea can be categorized into two types based upon the stage of their occurrence in a woman’s life.

Primary amenorrhea:

Primary amenorrhea is the absence of menstruation up until the age of 16. Menarche is the first menstrual cycle that a woman experiences, and it can be due to factors such as geographic regions, lifestyle, and other characteristics. Primary amenorrhea is a result of normal internal organs of a female not working properly or genetic reasons due to which internal organs did not properly form during the fetal development. Primary amenorrhea may occur due to the following reasons:

• It can occur as a result of a disease affecting the hypothalamus and pituitary glands which may hinder their ability to release estrogen and progesterone.
• Another cause for this condition is gonadal digenesis. This disease occurs when the ovaries are depleted of egg cells which can then lead to its failure.
• Turner’s syndrome is a rare genetic disorder in which a female is missing the usual pair of 2 X chromosomes which affects the proper growth and development.
• A chronic illness may also cause primary amenorrhea.
• A hymen which is not perforated.
• Excessive physical activities especially for athletes.
• Congenital disabilities such as a blockage in the opening of the womb and an improper growth of the uterus or vagina can be reasons for amenorrhea. It is common among girls who are very thin or athletic, such as young ballet dancers. They have less weight which means that their bodies have yet to experience a puberty-related rise in body fat that allows menstruation to commence.

Secondary amenorrhea:

This second type refers to the ceasing of an established menstruation, usually occurring in women aged 40 to 55. A woman may be suffering from secondary amenorrhea if her regular periods have suddenly stopped for three consecutive months, given that she's had them on a regular basis. For women who suffer from irregular periods, they may have amenorrhea if their missing menstrual periods  last up to at least nine months. Below are a few reasons why secondary amenorrhea happens:

• Pregnancy happens to be the most common cause of missed periods.
• Regular breastfeeding (lactational amenorrhea) can be a form of contraception as the woman becomes temporarily infertile post childbirth.
• Menopause
• Stress (emotionally or physically)
• Rapid weight loss
• Hormonal birth control methods like consumption of birth control pills
• Chemotherapy
• Tumors in pituitary glands
• Premature failure of ovaries
• Medications like corticosteroids, blood pressure, and chemotherapy can disturb the normal cycle of menstruation.
• Chronic health conditions such as ovarian syndrome, thyroid disease, and cancer can cease menstrual cycles and, in some cases, the medications used to treat them.

Symptoms of amenorrhea:

The main symptom for the diagnosis of amenorrhea is the absence of a woman’s period. Other symptoms include:

• Headaches
• Hair growth in unwanted areas like the face
• Breast changes such as milky nipple discharge or swelling
• Pelvic pain and acne
• Nausea
• Skin changes
• Altered sex drive
• Changes in vision

Treatment of amenorrhea:

Your specific condition determines the treatment you will be provided with. The doctor shall carry out certain tests to diagnose the underlying cause of the ceased menstruation. These tests include:

• Pregnancy test - It will be performed to rule out or confirm any possibility of being pregnant.
• Blood and urine tests - These tests help in analysing the imbalances of the hormones. These imbalances can be a result of problems with either pituitary glands or ovaries.
• Pelvic ultrasound - This test is carried out to identify structural problems in the uterus and ovaries with the help of sound waves.
• Male hormone test - This test is carried out by a doctor if you are experiencing increased facial hair growth and a lowered voice. This is done primarily to check the level of male hormones in your body. 
• Progesterone challenge test - In this test, your doctor treats you with progesterone to see if it can initiate menstruation.
• Other tests include the checking your thyroid and ovary. These tests are done to rule out or confirm the possibility of pituitary gland tumor.

Based upon the underlying condition, your doctor will recommend you with the medications and lifestyle changes that address your problem. Lifestyle factors, like too much exercise and eating too little, can lead to amenorrhea. Maintaining a healthy weight, reducing stress, and adjusting physical exertion helps in balancing the hormone levels in the body which, in turn, helps in triggering periods.

In some cases, the use of home remedies can start the menstrual cycle. However, amenorrhea caused by pituitary or thyroid disorders will require treatment with medications. Certain oral contraceptives can also help in restarting the menstrual cycle. In case the problem is due to any tumor or structural blockage preventing menstrual cycles from occurring, surgery will usually be recommended for treatment.