When women experience the absence of menstruation, they instantly go to the pharmacy and buy a pregnancy test. Usually, the absence of menstruation is the synonym of pregnancy. However, when the menstruation is not coming for a couple of months in a row and the pregnancy test is negative, then this is something else. This is amenorrhea.
If the pregnancy possibility is excluded, amenorrhea may include many other problems that involve the reproductive organs or the glands that help regulate the hormone levels. Fortunately, this is a condition that can be treated. Many treatments have been developed that help to resolve the amenorrhea.
What Can Cause Amenorrhea?
A woman of reproductive age is considered to have amenorrhea when she deals with the absence of the menstrual period. The factors that can lead to this condition are multiple, however, there are few which are most common. First of all, the women who exercise a lot on a regular basis and who lose a significant amount of weight might deal with amenorrhea. When it appears due to these factors, then we are talking about Functional Hypothalamic Amenorrhea (FHA). Stress, excessive weight loss, and intensive workout might lead to the development of this condition. This happens because the women who are in this situation do not take in enough calories that will help them maintain a normal menstrual cycle. On the other hand, the weight loss can cause elevations in the hormone ghrelin which inhibits the hypothalamic-pituitary-ovarian axis.
The females who experience low levels of hormone leptin caused by low body weight are experiencing secondary amenorrhea. Leptin works just like ghrelin and it signalizes energy balance and fat stores to the reproductive axis. Moreover, there are also cases when because of the lack of eating, the women experience amenorrhea and bone loss. This leads to osteopenia which then progresses into osteoporosis.
If we were to think from the social point of view, the amenorrhea caused by excessive weight loss may have various implications. Usually, amenorrhea is associated with anorexia nervosa, which brings many other effects for the patient. When the secondary amenorrhea appears at an early stage in life, then it might be possible that the woman cannot become pregnant, not even if she is following a treatment for fertility. On the other hand, the long-term amenorrhea can also cause an early menopause due to the estrogen deficiency. Furthermore, when the woman’s ovaries do not produce estrogen because of amenorrhea, then that woman might experience severe calcium loss. This can turn into osteoporosis that has its own implications in the long term.
There are cases when the amenorrhea is drug-induced. The contraceptive medication is used by many women all around the world usually to avoid a pregnancy. This is a healthy method that induces amenorrhea. However, the extended cycle use of combined hormonal contraceptives may also allow suppression of menstruation. There have been cases when the patients who stopped using contraceptives have also dealt with a secondary amenorrhea as a withdrawal symptom.
Leaving the contraceptives aside, there are also other drugs that can induce amenorrhea. The long-term use of opiates on a regular basis has been shown to lead also amenorrhea. The treatment used to treat schizophrenia, for instance, antipsychotic drugs, has been shown to cause amenorrhea as well. The studies done in this area have shown that by adding a dosage of Metformin to an antipsychotic treatment can restore the menstruation.
Secondary amenorrhea may also appear as a consequence of breastfeeding. This condition lasts often for around 6 months, but the period might vary depending on how often the woman is breastfeeding. Lactational amenorrhea is still seen, on the other side, as an efficient method of family planning. There are countries where the access to other methods of contraception is very limited, and so the lactational amenorrhea is an excellent method of contraception. Its efficiency of 98% can be seen as a very efficient method to prevent a pregnancy in the first 6 months postpartum.
This condition may also appear due to physical deformities. For example, the Mayer–Rokitansky–Küster–Hauser syndrome is considered the second-most common cause of primary amenorrhoea. Women may recover from MRKH syndrome, but other times primary amenorrhoea, which is characteristic of the disorder, may prevent pregnancy for life.
What Are The Symptoms of Amenorrhea?
As it is already clear from this condition definition, the most striking sign is the absence of menstrual period. However, depending on what causes the condition, there might be some signs and symptoms that come together with it:
- Milky nipple discharge
- Hair loss
- Vision changes
- Excess facial hair
- Pelvic pain
Learn If You Are At Risk
According to one of the latest studies conducted by the American Society for Reproductive Medicine, only 3-4% of the women experience amenorrhea due to other causes than pregnancy, breastfeeding, or menopause. What is more, the same study has shown that the secondary amenorrhea is the most common type.
Usually, the risk factors that lead to amenorrhea are the following:
- The family history can play an important role as you might inherit the predisposition to this problem
- The eating disorders, such as bulimia, obesity or anorexia, might also represent a high risk that causes amenorrhea
- Intensive training is also responsible for producing amenorrhea.
Tests and Diagnosis
As soon as you experience more than 3 months of lack of menstruation period and you are more 15 years old, then you should see a doctor. As soon as the doctor starts the examination, he will first do a pelvic exam to see if it is something wrong with your reproductive organs. If we are talking by girls under 15 years old, then the doctor will check for primary amenorrhea. He will check the patient for the presence of secondary sex characteristics like enlarged breasts and body hair. In the absence of secondary sex characteristics, the most common cause of amenorrhoea is low levels of FSH and LH caused by a delay in puberty.
In case the amenorrhea appears as a consequence of other hormonal problems, then the tests might be more complex.
A variety of blood tests may be necessary, including:
- A pregnancy test is the first test a doctor recommends to check if the patient is pregnant.
- Thyroid function test will help the doctor measure the amount of thyroid-stimulating hormone (TSH). The TSH will help the doctor understand if the thyroid is working properly.
- Ovary function test is used to measure the amount of follicle-stimulating hormone (FSH) in your blood and helps to determine if your ovaries are working properly.
- Prolactin test show if the hormone prolactin has low or high levels. In the case of low levels, then this might be a sign of a pituitary gland tumor.
- Male hormone test. If you’re experiencing increased facial hair and a lowered voice, your doctor may want to check the level of male hormones in your blood.
Hormone challenge test
In this case, the doctor usually recommends a hormonal medication that will eventually trigger the menstrual bleeding. The recommendation is to follow this treatment for 7 to 10 days. The menstruation should appear during this period unless the patient is experiencing any other problems that might lead to other more complex investigations.
Depending on your signs and symptoms — and the result of any blood tests you’ve had — your doctor might recommend one or more imaging tests, including:
- Ultrasound helps the doctor check for any abnormalities in your reproductive organs. It is very efficient especially for the patients who have never had menstruation.
- Computerized tomography (CT) can indicate whether your uterus, ovaries, and kidneys look normal.
- Magnetic resonance imaging (MRI) is used usually to check for a pituitary tumor.
If other testing reveals no specific cause, your doctor may recommend a hysteroscopy — a test in which a thin, lighted camera is passed through your vagina and cervix to look at the inside of your uterus.
Is There Treatment for Amenorrhea?
When we are talking about primary amenorrhea, this does not need a special treatment. The primary amenorrhea is caused by late puberty. This means that as the patient grows older, the condition will go away on its own. On the other hand, if the primary amenorrhea is caused by genetic abnormalities, then the treatment for it depends a lot on the problem. For example, if the patient’s ovaries are not functioning properly, then she will be prescribed supplemental ovarian hormones. In addition, the ovarian hormones will enable the appearance of secondary sex characteristics.
When the amenorrhea comes as a consequence of the menopause or hysterectomy, then the doctor will prescribe a treatment which is specially made for this condition. It will help prevent the complications that appear because of low estrogen levels.
There are also other forms of secondary amenorrhea, which can be treated in other ways like follows:
- If the amenorrhea is caused by stress, then the doctor will recommend a solution to help reduce the stress levels.
- Obesity may also be a cause of secondary amenorrhea. Then the patient should follow an exercise program and a diet that will help her lose weight.
- The excessive athletic training can be moderated a bit in order to help the patient stay in a good shape, but at the same time, not be intensive enough in order to produce secondary amenorrhea.
- Hormone imbalance. Your doctor may prescribe supplemental hormones.
- Polycystic ovary syndrome. Multiple medical treatments, like metformin or clomiphene, can help regulate menstrual periods.