An Overview of Amenorrhea

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That moment you realize you haven't gotten your period in quite some time can be quite alarming. "Am I pregnant?" you wonder. "I can't be pregnant!"

After ruling out pregnancy, you might then become concerned that something is more deeply wrong. There can be a number of causes of the absence of menstruation, also known as amenorrhea.

Amenorrhea Symptoms

Amenorrhea is defined as missing three menstrual periods in a row if you usually have regular menstrual cycles, or no menstruation for over six months if you have had irregular menstrual cycles. You also have amenorrhea if you were assigned female at birth and have not yet begun menstruation by age 15.

Some of the signs or symptoms you may experience in addition to the absence of menstruation include:

Be thorough in reporting all symptoms to your doctor as they can help point to the underlying cause of amenorrhea.

Call your doctor for testing and diagnosis of the cause of your amenorrhea. Treatment of the underlying condition will typically resolve your amenorrhea.

Causes

While the most common cause of amenorrhea is pregnancy, it's not the only culprit. Other causes include medications, lifestyle, and problems with the reproductive organs or with the glands that help regulate hormone levels.

Natural Causes

Natural causes for amenorrhea include:

Medications

There are also certain medications that can cause menstrual periods to stop, including some types of:

Lifestyle

There may also be some aspects of your lifestyle contributing to the cessation of your period. These include:

  • Low body weight can interrupt the hormonal functions in your body, halting ovulation.
  • Women who have an eating disorder, such as anorexia or bulimia, often stop having periods because of these abnormal hormonal changes.
  • Excessive exercise can also lead to amenorrhea, because of low body fat, stress, and high energy expenditure.
  • Mental stress can temporarily alter the functioning of your hypothalamus, the area of your brain that controls the hormones that regulate your menstrual cycle.

Hormonal Imbalance

There are several medical issues that can lead to hormonal imbalances that affect menstruation, including:

Structural Causes

Problems with the sexual organs themselves can also cause amenorrhea. Examples include:

  • Uterine scarring
  • Lack of reproductive organs
  • Structural abnormality of the vagina

Diagnosis

Your doctor will perform a pelvic exam to check for any problems with your reproductive organs. If you've never had a period, your doctor will examine your breasts and genitals to see if you're experiencing the normal changes of puberty.

Because there are so many possible causes of amenorrhea, multiple tests may be required, including:

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.

Treatment

The treatment your doctor recommends depends on the underlying cause. In some cases, hormonal contraceptives (the pill) or other hormone therapies can help. In other cases, medication or even surgery will be more appropriate.

Beyond your doctor's suggestions, however, you may want to also think about finding greater balance in your exercise regimen, your diet, and more. Look for ways in which you may be able to decrease the stress in your life. And as always, remain mindful of what your body is telling you.

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Article Sources
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  1. Mayo Clinic. Amenorrhea - symptoms and causes.

  2. Pinkerton JV Amenorrhea - gynecology, and obstetrics." Merck Manuals Professional Edition. Updated July 2019.

  3. MedlinePlus Medical Encyclopedia, "Absence of menstruation (amenorrhea)"

Additional Reading
  • Bielak, Kenneth M., M.D., and Gayla S. Harris, M.D. "Amenorrhea." : Background, Pathophysiology, Etiology.

  • Pinkerton, JoAnn V., M.D. "Amenorrhea - Gynecology, and Obstetrics." Merck Manuals Professional Edition.