Amenorrhea

An Overview

Amenorrhea is when you aren’t getting your periods even though you’ve been through puberty, aren’t pregnant, and haven’t gone through menopause. It’s not about having irregular periods. If you have amenorrhea, you never get your period. Although it’s not a disease, you should tell your doctor about it because it might be a symptom of a medical condition that can be treated.

Amenorrhea is the absence of menstruation (your monthly period). Primary amenorrhea means your period did not start by age 16. This is usually because of a lack of reproductive organs, such as a uterus. Breasts and other signs of puberty that usually start to develop by age 14 do not develop.

Amenorrhea Types

There are two types of amenorrhea:
Primary amenorrhea. This is when young women have not had their first period by the age of 15. Primary amenorrhea refers to the absence of menstruation in someone who has not had a period by age 15. The most common causes of primary amenorrhea relate to hormone levels, although anatomical problems also can cause amenorrhea.
Secondary amenorrhea. This is when you have had normal menstrual cycles, but they stop for 3 or more months. Secondary amenorrhea refers to the absence of three or more periods in a row by someone who has had periods in the past. Pregnancy is the most common cause of secondary amenorrhea, although problems with hormones also can cause secondary amenorrhea.

Symptoms for amenorrhea

Besides not having your period, there are some other symptoms you may have, depending on the cause of your amenorrhea:
• Pain in your pelvic area
• Changes in your vision
• Headaches
• Acne
• Hair loss
• More hair growth on your face
• A milky discharge from your nipples
• No breast development (in primary amenorrhea)

Causes of Amenorrhea

Amenorrhea can occur for a variety of reasons. Some are normal, while others may be a side effect of medication or a sign of a medical problem. Many things could cause 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. Possible causes of primary amenorrhea (when you never get your first period) include:
• Failure of the ovaries
• Problems in the central nervous system (brain and spinal cord) or the pituitary gland (a gland in the brain that makes the hormones involved in menstruation)
• Problems with reproductive organs
In many cases, doctors don’t know why a first period never happens.
Common causes of secondary amenorrhea (when someone who has had normal periods stops getting them) include:
Contraceptives
Some people who take birth control pills (oral contraceptives) may not have periods. Even after stopping birth control pills, 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

Diagnosis

Amenorrhea is a symptom, not an illness. The doctor will aim to find out why there is no menstruation.
Primary amenorrhea
If an individual has not started menstruating by the age of 16 years, a doctor may ask about their family history and carry out a number of tests.

They may then recommend a number of tests, depending on what the cause appears to be.

These may include:

  • a pregnancy test
  • a thyroid function test
  • ovary function test
  • androgen and other hormone tests

Imaging tests may include:

  • an MRI, CT, or ultrasound scan
  • a hysteroscopy, in which the doctor passes a thin, lighted camera through the vagina and cervix to examine the uterus from the inside.

Treatment

Primary amenorrhea

Treatment for primary amenorrhea may start with watchful waiting, depending on the person’s age and the result of the ovary function test. If there is a family history of late menstruation, periods may start in time.

If there are genetic or physical problems that involve the reproductive organs, surgery may be necessary. This will not guarantee, however, that normal menstrual cycles will occur.

Secondary amenorrhea

This will depend on the underlying cause.

Lifestyle factors: If the person has been exercising excessively, a change of exercise plan or diet may help to stabilize the monthly cycle.

Stress: If emotional or mental stress is a problem, counseling may help.

Excessive weight loss: This can happen for different reasons. The person may need a professionally supervised weight gain regime. If an eating disorder is a possibility, treatment may include a weight-gain regime and counseling sessions with a psychiatrist and a nutritionist or dietitian.

Some health conditions can cause weight loss. A doctor may test for these and offer treatment as appropriate.

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