When women miss consecutive 3 periods or when girls do not get menstrual periods till the age of 16, it is called amenorrhea. It is of two types – primary amenorrhea and secondary amenorrhea. Primary amenorrhea is absence of menstrual bleeding in a girl by the age of 16 years with normal development of all the other secondary sexual characters and secondary amenorrhea is absence of menstrual bleeding in a women more than 3 months without any pregnancy and lactation.
Pregnancy is the major cause of amenorrhea. Further reasons can be problems associated with the reproductive organs or hormone regulating glands.
1. Natural causes of amenorrhea
Following are natural reasons of amenorrhea which occur in the regular course of a woman’s life may alter the menstruation cycle:
- When a women is pregnant, she misses periods.
- Breastfeeding also leads to change in the cycle of menstruation
- Menopause is also a reason.
Women may miss periods who consume contraceptive pills. Normal ovulation and periods may take 3-6 months to restart when the birth control pills intake is stopped.
Few antidepressants, chemotherapy, blood pressure and antipsychotic drugs may lead to stopping of menstrual periods.
4. Lifestyle factors
Several lifestyle factors are also the cause of amenorrhea. These can be:
Function of hypothalamus is altered by stress. Hypothalamus controls the menstrual cycle regulating hormones. Due to this, ovulation and menstruation might stop. When the stress is reduced or eradicated, the periods start.
b. Less body weight
When body weight is very low, it affects and disrupts the hormonal functions. This causes stopping of ovulation.
c. A lot of exercise
Women who are involved in gymnastics, running, ballet have to undergo a lot of extensive training. These women face the problem of stopping of periods. Low body fat and spending a lot of energy can be a cause of this.
5. Hormonal imbalance
Some medical problems like thyroid malfunction, pituitary tumor, polycystic ovary syndrome or premature menopause cause a lot of hormonal imbalance, thus altering or stopping the period cycle.
6. Structural problems
At times, the sexual organs face some problems thus causing amenorrhea. These are:
a. Absence of reproductive organs. Some girls, due to problems during development of the fetus, do not have reproductive system’s major parts (cervix, uterus or vagina). So they do not have menstrual cycles.
b. Abnormality in the structure of the vagina. Menstrual bleeding is not visible, when there is barrier in the path of the vagina. This is due to some membrane which blocks the flow of the fluid.
The most common sign of a women having amenorrhea is the absences of menstrual periods. All or some of the following symptoms can be seen in women having amenorrhea, depending on the cause of amenorrhea:
- Discharge from nipple which will be milky
- Loss of hair
- Alteration in vision
- Facial hair which are more than normal
Pelvic examination is done for diagnosing any reproductive organ problem. If your periods have not started, the doctor will check the genitals and breasts to see, if puberty changes are taking place or not.As Amenorrhea can be caused by varied reasons, it might take different types of test to find the exact cause of it. These are as given below.
1. Laboratory tests
Blood tests will be done to find the following:
a. Pregnancy test
b. Thyroid function test. To find that exact situation of the thyroid-stimulating hormone (TSH).
c. Ovary function test. To check whether ovaries are working appropriately. This is done by gauging the quantity of follicle-stimulating hormone (FSH).
d. Male hormone test. This test is done, if there is symptom of more than normal facial hair.
2. Hormone challenge test
To check, if estrogen deficiency is the cause of amenorrhea; the doctor will give you a hormonal medication, which you will have to take for 7 to 10 days. These are given to start the menstrual bleeding.
3. Imaging tests
Imaging test might be recommended by the doctor. He will desire to conduct imaging test after seeing the result of the blood test and also the symptoms of amenorrhea in you. These can be:
a. Ultrasound. This enable the doctor to see the internal organs of your body and whether reproductive organs have been developed in your body or not .
b. Computerized tomography (CT). To check if kidneys, ovaries and uterus are normal. The CT scan is done to see the cross-sectional image of the body structures.
c. Magnetic resonance imaging (MRI). In order to check for pituitary tumor, the doctor might ask you to get an MRI done.
4. Scope tests
This test is done only, if the doctor is not able to diagnose any specific cause. In this test, in order to look at the uterus, a camera is passed from vagina and all the way through the cervix.
Treatments and drugs
Depending on the cause of amenorrhea, the doctor suggests the treatment. For restarting menstrual cycle at time, contraceptive pills are effective. If there is thyroid or pituitary disorder, medicines can be given to cure it. If there is some structural issue then the doctors advise surgery.