Amenorrhoea – Absence of menstruation 

What is amenorrhoea?  

Amenorrhoea is the absence of menstruation or periods. Regular menstrual cycles are a vital indicator of general health. 

Missing periods which is not due to pregnancy, menopause or breastfeeding usually indicate another medical condition. Consulting a doctor is important during such situations. 

Types of amenorrhoea 

Primary amenorrhoea 

Primary amenorrhoea is the absence of menstruation by the age of 16 years. This is very rare. 

The causes may be 

• Absence or malfunction of reproductive organ  
• Absence of hormones essential for menstruation to commence 
• Genetic or chromosome abnormality, such as Turner syndrome. 

Secondary amenorrhoea 

Secondary amenorrhoea occurs when periods stop continuously for three months or longer. This is typical during pregnancy and the time before menopause. 

Cause includes, 

• Excessive physical activity 
• Depression and anxiety 
• Premature menopause 
• Intensive athletic training 
• Oral contraceptives or Intrauterine devices (IUDs) 
• Low body weight and poor nutrition, such as anorexia nervosa and other eating disorders 
• Antipsychotic medicines 
• Polycystic ovarian syndrome (PCOS)  
• Thyroid or pituitary gland issues. 

Athletic amenorrhoea 

Athletic amenorrhoea occurs when strenuous exercise suppresses the release of oestrogen, resulting in the cessation of periods. 

Causes of Amenorrhoea  

Amenorrhoea can occur for a number of causes and is usually a symptom of another medical issue. It may happen as a regular occurrence in life, such as during pregnancy or breastfeeding.  

It might also be a symptom of a medical condition like polycystic ovary syndrome (PCOS). Understanding amenorrhea is important since it is linked to health issues connected to infertility. 

Primary amenorrhoea 

Primary amenorrhoea, defined as the absence of menses by the age of 16, can have the following causes: 

• The ovaries may stop working, usually due to chromosomal or genetic disorders. 

• Hormone imbalances arising due to issues with the pituitary or hypothalamus in the brain might delay the onset of menstruation.  

• Extreme physical or mental stress, eating disorders, excessive exercise or a combination of these conditions can interfere with the hypothalamus or pituitary gland’s regular function, delaying the start of menstruation. 

• Occasionally, physical issues, including missing reproductive organs or a block in the reproductive system, can also cause primary amenorrhoea.  

Secondary amenorrhoea 

Secondary amenorrhoea occurs when a woman skips three consecutive periods or misses periods for six months after normal menstruation. 

Some of the causes include, 

• Secondary amenorrhoea most frequently occurs naturally during pregnancy. 

• Menopause and lactation are two other physiological factors for amenorrhoea. 

• Amenorrhoea can occur due to some hormonal intrauterine devices (IUDs), birth control tablets and injectable contraceptives. After stopping one of these birth control methods, it may take several months for the menstrual cycle to start again and become regular.  

• Amenorrhoea may also be caused by other drugs. 

• Hypothalamic amenorrhoea – This disorder develops when the release of gonadotropin-releasing hormone (GnRH). This hormone initiates the menstrual cycle and slows or ceases in the hypothalamus, a brain organ that controls bodily functions. 

• PCOS and other gynaecological problems 

• Thyroid issues. 

• Pituitary tumours. 

Amenorrhoea signs and symptoms

The primary symptom of amenorrhoea is missing periods. 

A woman may also have additional indications or symptoms, depending on the cause, like 

• Headache 
• Hair fall 
• Excessive facial hair 
• Milky discharge from breasts 
• Lack of breast development 
• Modifications in vision 

Talking to a healthcare professional is essential if the periods are irregular or there is an absence of periods. 

Duration of amenorrhoea  

When the cause of amenorrhoea is determined and treated, the menstrual cycle resumes. 

Sometimes it’s necessary to address the problems that prevent periods, such as overexerting oneself, being overweight or too thin, or being under too much stress.  

Amenorrhoea is another side effect of contraception. This is not harmful, and the period will usually start again three months after a person stops using them.  

Amenorrhoea diagnosis  

To determine the cause of the amenorrhoea, the doctor may request a medical history and perform various tests. 

• Pregnancy test 
• Blood tests to check hormonal levels 
• Physical examination  
• Scans of the abdomen, pelvis, reproductive organs, and skull (to evaluate the pituitary gland)  

A doctor starts by discussing the medical history, food and exercise routines, and any medications or supplements the patient may be taking. 

The patient might also need to mention the regular menstrual cycle, including how long it has been since the last period. It is, therefore, important for all women to routinely keep track of their cycle, using a calendar or a period tracking mobile application. 

A pelvic examination is done to diagnose any physical defects. A pelvic ultrasound may be carried out on a teen with primary amenorrhoea if birth abnormalities are suspected. 

Blood tests are done, including pregnancy tests and hormone level tests, including estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormones and others.  

A head CT scan or MRI is suggested to screen for a tumour in the patients when diagnosis becomes difficult with other tests. 

Treatment option for amenorrhoea  

The underlying cause of amenorrhoea, as well as the patient’s health, influence the course of treatment. 

Keep an eye out for changes in the menstrual cycle. Consult a doctor for any queries. Note the dates of the periods in a journal or an app. The day the period begins, its duration and any issues should be noted. The start of the menstrual cycle is seen as the first day of bleeding. 

Medical treatment 

The following are typical medical interventions for secondary amenorrhoea. 

• Birth control pills or other hormonal drugs – Some oral contraceptives help in resuming the menstrual cycle. 

• Estrogen replacement therapy (ERT) – ERT helps balance hormone levels in women with primary ovarian insufficiency (POI) or Fragile X-associated primary ovarian insufficiency (FXPOI). This helps start the menstrual cycle.  

ERT substitutes for the natural oestrogen that a woman’s body should be producing for a regular menstrual cycle. In addition, ERT might assist FXPOI-affected women in reducing their chance of developing osteoporosis. The doctor may also give progestin or progesterone to lower this risk, as ERT can increase the chance of uterine cancer. 

• PCOS medications – To help with ovulation, doctors frequently give clomiphene citrate (CC) medication. 

• Medications are generally safe, but they can also have adverse effects, some of which may be very dangerous. Before choosing a specific course of therapy, discuss potential risks and side effects with the doctor. 

Surgery 

Surgery can be used to treat amenorrhoea, though it is not frequently advised. 

These include 

• Uterine scarring – This is a surgery to remove scars in the uterus. Uterine scarring results from a miscarriage, a cesarean section, uterine fibroids removal or a dilatation and curettage (D&C), a procedure in which tissue is taken from the uterus to diagnose or treat severe bleeding or to clear the uterine lining after a miscarriage. 

• A treatment known as a hysteroscopic resection can help restore the menstrual cycle by removing the scar tissue. 

Risk factors 

Risk factors for amenorrhoea include,  

• Obesity 
• Excessive exercise 
• Family history of amenorrhoea 
• Early menopause 

• Eating disorders 
• Genetics (Having a modified FMR1 gene). 

Prevention  

Maintaining a healthy body weight and performing adequate physical activity to help control the menstrual cycle.  

The absence of a period may or may not indicate a medical issue. However, if a natural diagnosis cannot be made, it can indicate a problem with the hormonal or reproductive system.  

Depending on a woman’s oestrogen level, there are different amenorrhea risks. Low oestrogen levels, for instance, might lead to osteoporosis or infertility, whereas high oestrogen levels are associated with endometrial cancer. 

When to see a doctor?  

If the menstruation is missed for three months, one should contact a doctor.  

Visit a doctor if you, 

• Have balance, coordination, or vision issues (these symptoms could point to a more severe illness). 
• Have less than 9 periods a year.  
• They have not yet experienced the first period and are older than 15 years. 

• Notice changes in the period’s pattern. 

Conclusion  

The absence of menstruation or periods is known as amenorrhoea. A girl older than 15 years who hasn’t had her periods or experiences sudden missing periods should consult a doctor. 

Usually, amenorrhea indicates a disorder that can be treated. One can receive treatment to control the cycle once the doctor diagnoses the cause of missing periods. To help restore regular menstrual cycles, a person may need to make lifestyle changes or receive hormonal therapy. 

FAQs  

What is the major cause of amenorrhea?  

Family history, genetics, and lifestyle are the key contributors to primary amenorrhea. The following factors increase the risk for women—a history of amenorrhea or early menopause in the family and an inherited or chromosomal defect. 

Is amenorrhea harmful?  

There are numerous causes of amenorrhea. It might be caused due to drugs or hormone imbalances, or it can occasionally happen as a normal part of life. Amenorrhea is not life-threatening and frequently indicates a problem that may be treated. Menstruation can resume after treatment. 

Does PCOS cause amenorrhea?  

Amenorrhea can occur for several causes and is frequently a symptom of another medical issue rather than an illness in and of itself. It might also be a symptom of a medical condition like polycystic ovary syndrome (PCOS). 

How can I restore my period?  

To restore menstrual periods,  

• Do some yoga 
• Maintain ideal weight 
• Exercise regularly 
• Consume ginger 
• Include some cinnamon. 
• Get the recommended daily vitamin intake to be healthy.