You might have heard the term amenorrhea and you’re looking for more information on the subject. Let’s look at what amenorrhea is, the risk factors and causes, the symptoms, treatment options and anything else you need to know about this condition
What is amenorrhea?
Amenorrhea is the absence of, or the abnormal cessation of, menstruation. The word amenorrhea comes from Greek and it’s divided into three parts.
‘A’ means no; ‘men’ means month; and ‘rhoia’ means flow. In other words: ‘no monthly flow’
What are the types of amenorrhea?
There are two types of amenorrhea: primary and secondary amenorrhea.
We talk about primary amenorrhea when a woman has never had a menstrual period.
Secondary amenorrhea is diagnosed when a woman no longer has a menstrual period but had been menstruating prior to the secondary amenorrhea diagnosis.
The normal menstrual cycle
During a normal menstrual cycle there’s a lot of hormonal flow involved. Day 1 of the menstrual cycle is the first day of your period. As you can see in the graphic, the level of all hormones is quite low.
As the cycle advances towards ovulation, the luteinizing hormone starts to be secreted in larger quantities and it reaches its peak right before ovulation. The hormone estrogen and follicle-stimulating hormone reach their maximum peak at the time of ovulation.
The hormone progesterone starts to rise in the body in the second half of the menstrual cycle, in case pregnancy occurs. If pregnancy doesn’t occur, the levels of all these hormones decrease again and menstruation occurs once more.
Read more about this in our article Menstrual Cycle – Stages, Phases And What To Expect.
Risk factors and causes of amenorrhea
As we’ve just seen, there’s a perfectly synchronised hormonal balance for menstrual cycles to happen. Anything that causes an imbalance in the secretion of these hormones can increase the chances of developing amenorrhea.
Some of these are:
- Family history of amenorrhea or early menopause
- Being underweight or overweight. This can create a hormone imbalance and might have an impact on your cyclicity. Rapid weight loss or weight gain might also negatively affect your hormone health network
- The presence of a genetic or chromosomal condition that can affect your menstrual cycle, such as Turner syndrome.
- An eating disorder. Eating disorders, such as anorexia nervosa, can alter your hormonal balance to the point of developing amenorrhea. The treatment of eating disorders might require a large professional multidisciplinary team, with endocrinologists as well as mental health specialists
- A poor diet. Sometimes you don’t need to suffer an eating disorder for your diet to affect how your body functions. A poor diet can be enough to cause amenorrhea
- A chronic condition that might affect the normal function of the reproductive system, such as polycystic ovary syndrome (PCOS)
- Tumors. A tumor might grow in a place where it prevents some of the reproductive organs from functioning properly. The female reproductive system is mainly located in the woman’s lower abdomen but there are certain areas of the brain that are critical for the right hormonal secretion. A pituitary tumor might well explain a secondary or even primary amenorrhea
- Premature ovarian failure, when the ovaries stop producing viable eggs. This is considered ‘premature’ if the woman is still considered young to be entering menopause
- Primary ovarian insufficiency. The ovaries led by the pituitary gland are in charge of the release of most female hormones. Primary ovarian insufficiency is diagnosed when the ovaries cease functioning before a woman is 40 years old.
What are the symptoms of amenorrhea?
The main symptom of amenorrhea is the absence of a menstrual period.
However, the absence of menstruation tends to come accompanied by other symptoms, such as:
- Vision disturbances
- Hair loss and hair growth
- Changes in breast size
- Milk leakage
- Vaginal dryness.
How is amenorrhea diagnosed?
Primary amenorrhea is diagnosed when a girl turns 15 years of age without having had a menstrual period or when it’s been five years since the first signs of puberty but there has been no menstruation.
Secondary amenorrhea is diagnosed when a woman stops getting her periods for three months or longer.
When should I see my healthcare provider about amenorrhea?
We’ve seen there are two types of amenorrhea. As the causes of primary amenorrhea are different from the causes of secondary amenorrhea let’s differentiate between them to determine when to seek help.
When a girl is suspected of having primary amenorrhea it’s a good idea to take her to a midwife or a gynaecologist. It might be that she’s a ‘late bloomer’ but it’s important to start looking for causes of primary amenorrhea.
Your healthcare provider will take a medical history and do a physical exam to look at various parameters of puberty, such as breast development, bone health, diet, exercise routine and general child health.
Your provider might ask for further testing, including blood tests, to try to determine the cause of primary amenorrhea. Testing might involve the thyroid and pituitary glands. Research shows that the cause of primary amenorrhea is often hormonal.
When menstrual bleeding stops without a known cause, it’s important to find the underlying cause. Although diagnosing amenorrhea might be easy, finding out what’s causing the secondary amenorrhea can be quite difficult, as it can mean a problem with the reproductive organs, the pituitary gland or involve other underlying causes.
Treatment and medication options for amenorrhea
There are different treatments for different types of amenorrhea, depending on its cause. Treating the underlying cause will resolve the amenorrhea in most cases.
- Many caregivers will commence treatment by prescribing birth control pills or other hormone therapy
- Thyroid-stimulating hormone therapy has had great results in treating primary and secondary amenorrhea
- Lifestyle factors. When a healthy life style is regained, amenorrhea is most often resolved naturally. A gradual weight gain or loss, physical activity and rest will bring hormonal balance back to standard levels
- Tumors. If the cause of amenorrhea is a tumor, surgery might be necessary.
Is amenorrhea caused by stress?
As we’ve seen, there are different causes of amenorrhea.
Long-lasting stress can have a negative effect on a person’s hormonal balance. Oxytocin and adrenaline are opposed hormones. Oxytocin is the ‘love hormone’ and adrenaline is the stress hormone.
These hormones are antagonistic, which means that one cannot exist in the presence of the other. When oxytocin is secreted in the body, adrenaline levels are very low. The moment adrenaline rises, oxytocin secretion stops.
Our bodies thrive when oxytocin is present. The more oxytocin we secrete, the happier we are. When a woman is pregnant, the happier she is, the more the baby will thrive.
Stress is a defence mechanism the body goes into when certain hormones are released into the blood stream. This hormonal release is designed to provoke a physical response in the body. Once the threat has disappeared, the stress hormones will leave the body, allowing it to rest and regain its normal balance.
This is how our bodies would behave normally. The problem starts when the stressful event isn’t an isolated event.
When the presence of stress hormones in the blood flow starts to become a common occurrence, imbalances begin to develop. This is because stress shouldn’t be the normal status; the human body shouldn’t be in a permanently stressed situation.
When in stress mode, the human body wastes a huge amount of energy. If this happens on a regular basis, the hormonal equilibrium of the body starts to crumble. Remember that the normal status is high oxytocin, with low levels of adrenaline.
When there are high levels of adrenaline, there’s little oxytocin around. If this happens over an extended period of time, the hormonal dynamics change at brain level. Sometimes, if the stressor agent doesn’t go away soon enough, the release of catecolamins and stress hormones can affect the normal release of other hormones to the point of causing amenorrhea.
Let’s say that when the body is stressed it uses up most of its energy in resolving the stress. If this situation becomes permanent, other hormones are secreted in lower quantities than necessary, causing hormonal imbalances that can result in primary and secondary amenorrhea.
Can you get pregnant with amenorrhea?
This question is much trickier than it might seem.
Although it is possible to get pregnant with amenorrhea, it is unlikely – and difficult – if the cause of amenorrhea is not removed.
Earlier, we mentioned the hormones involved in the menstrual cycle. For pregnancy to occur the woman needs to ovulate and, or ovulation to occur, the hormonal menstrual balance needs to be optimal.
Once amenorrhea is corrected, ovulation will follow and then pregnancy will be more likely.
Understanding how our bodies (male and female) work is essential to understand our fertility.
If you’re hoping to get pregnant and finding it difficult, look at this natural fertility course we recommend Natural Fertility.
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