It’s common for women to experience period loss, and while it may seem like a blessing at first, it can be a sign of an underlying health issue that needs to be examined. Amenorrhea (pronounced amen·or·rhea) is the loss of menstruation in women of reproductive age. Whether amenorrhea is caused by stress, lifestyle changes, or a medical condition, understanding the causes and taking steps to address it is important. In this article, we’ll break down the two types of amenorrhea (primary and secondary), its causes, symptoms, and potential treatments to help you understand your body and when to seek medical advice from a professional.
What is Primary Amenorrhea?
Primary amenorrhea occurs when a woman does not have her first period by the age of 15 or within three years after breast development–a process known as thelarche. If this occurs, it could indicate an underlying health issue that you may want to consult with a healthcare provider for further evaluation.
What is Secondary Amenorrhea?
Secondary amenorrhea is more common and occurs when a woman who previously had a regular menstrual cycle stops menstruating for 3 months or more. Secondary amenorrhea also applies to women who have had at least one spontaneous period in the past but haven’t had one for 6 months or longer.
In both cases, whether you think you are experiencing primary or secondary amenorrhea, it is a good idea to consult with a healthcare provider to determine the underlying cause.
Underlying Causes of Amenorrhea
Causes of amenorrhea can be physiological, medical, and/or lifestyle influences.
Normal Physiological Changes:
These are natural causes, which may occur throughout your normal life and are typically not serious causes of concern. This includes:
- Puberty
- Pregnancy
- Breastfeeding
- Menopause
Potential Medical Conditions
Another potential cause of amenorrhea is anovulatory cycles, where the ovaries fail to release an egg during the menstrual cycle, resulting in missed or irregular periods. This condition may be caused by hormonal imbalances or certain types of medical conditions, including:
Polycystic Ovary Syndrome (PCOS):
This is a hormonal imbalance caused by excessive androgens. This is a group of hormones that regulate our reproductive function, leading to irregular periods when there are excess levels of hormones.
Thyroid disorders:
Both hypothyroidism and hyperthyroidism can affect menstruation. They stem from various factors such as autoimmune disorders, iodine deficiency, genetics, radiation, or surgical treatments. The disease stops your thyroid from producing the right amount of hormones and can be threatening when left untreated or poorly managed.
Pituitary disorders:
Conditions related to tumors or other issues in the pituitary gland can disturb hormonal regulation and lead to period loss. The pituitary gland is often known as the “master gland.” It releases crucial hormones, like estrogen and progesterone, which are essential for metabolic and reproductive mechanisms.
Premature ovarian failure:
The early loss of ovarian function before the age of 40 can result in period loss and may affect fertility. The exact cause is still unknown but could be linked to genetic factors or autoimmune diseases, where the body’s immune system mistakenly attacks the ovaries.
Chronic stress & mental health conditions:
Emotional or physical stress can disrupt hormone levels, leading to loss of menstruation.
Although these are potential causes, you should not directly assume they are the reasons for your period loss. Diagnosis for amenorrhea typically requires several rounds of medical tests before coming to a definite conclusion.
Lifestyle causes:
Excessive exercise:
Also known as athletic amenorrhea, intense physical exercise can interfere with menstruation due to low energy availability, stress on the body, and hormonal imbalances.
Low body weight:
A low body fat (about 10% under normal weight) or an eating disorder can result in period loss due to the trigger of stress signals that prioritize survival over reproductive functions. As a result, there is a decrease in hormone production and cessation of menstruation.
A research paper published by Chen et al. revealed that 60% of amenorrhea cases are correlated with lifestyle factors related to dieting for aesthetic reasons and eating disorders. When individuals engage in extremely restrictive eating patterns or have eating disorders like anorexia nervosa and bulimia, the body is triggered to enter a state of nutritional deprivation, which triggers a stress response and suppresses hormone production. Psychological stress caused by negative body image is also a contributing factor.
Stress of extreme lifestyle changes:
Major life changes, such as a new job, moving, or emotional stress can also trigger amenorrhea.
Symptoms of Amenorrhea: When To See A Doctor?
While the main symptom of amenorrhea is period loss, it can also be accompanied by additional symptoms depending on the causes. Individually, each of these symptoms may not be cause for concern, but if several of them consistently occur together over time, it could indicate a more serious underlying health issue. These symptoms include:
- Change in hair growth, skin texture, or acne
- Infertility
- Headaches or vision changes
- Mood swings
If you experience any of these symptoms along with missed periods for over three months, or if you haven’t had your first period by age 15, it is recommended to consult a doctor.
What To Expect During Your Appointment
Your doctor will ask you about your menstrual history, lifestyle, and any additional symptoms you have experienced. They may ask about specific medical history and testing you’ve done in the past. If there are signs your period loss is caused by hormonal issues or organ failure, the following tests might be conducted:
- Blood test: You may be asked to do a hormone level checkup to monitor your FSH, LH, and thyroid hormones. FSH and LH regulate ovulation, while thyroid hormones influence metabolism and can affect reproductive hormone balance, potentially impacting menstruation.
- Imaging tests: Ultrasounds are also common to check for conditions like PCOS and MRIs to examine the pituitary gland for tumors.
Potential Treatment Options
The treatment for amenorrhea depends on the underlying cause. Some common approaches you can expect are:
- Lifestyle changes: Your doctor may recommend reducing exercise, increasing caloric intake, and managing stress.
- Hormonal treatments: Birth control can be prescribed for hormone regulation. For PCOS, clomiphene citrate therapy or estrogen replacement therapy may be used. They help with either inducing ovulation or replenishing estrogen levels to help regulate the body’s menstrual cycle.
- Surgical treatment: For tumors or anatomical issues, surgeries such as laparoscopic surgery may be needed to remove or treat cysts and scar tissues on the ovaries or reproductive organs. For pituitary tumors, you may also need surgery or radiation therapy.
Long-term Effects of Amenorrhea
If left untreated, amenorrhea can lead to longer-term health conditions in some cases. These might include:
- Osteoporosis: a disease that weakens bones, caused by low estrogen levels.
- Increased risk of cardiovascular diseases: estrogen helps to maintain heart health, which means its absence can result in cardiovascular health issues.
- Infertility: prolonged amenorrhea may prevent the ability to conceive.
- Psychological impacts: hormone imbalances may lead to mental health issues such as anxiety or depression.
Conclusion
Amenorrhea is a complex condition that may stem from various underlying causes including physiological, medical, or lifestyle factors.
If you are experiencing period loss along with many other symptoms, it is important to seek professional medical advice to identify the cause and begin treatment. Early intervention can help manage symptoms and prevent serious health issues.
