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- What is Amenorrhea?
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What is Amenorrhea?
Amenorrhea is the term used to describe the condition where menstrual periods are absent. When you miss a period, your first thought may be that you are pregnant. However there are actually several factors that may cause or contribute to the absence of menstruation.
Menstruation refers to the shedding of the lining of the uterus (the endometrium) each month, and it is also commonly known as the menstrual period.
Menstrual periods usually last for five to seven days. In order for a woman to have regular menstrual cycles, her hypothalamus, pituitary gland, ovaries and uterus must be functioning properly. Her cervix and vagina must also be structured normally to allow for menstrual blood to pass through.
Types of Amenorrhea
Amenorrhea is classified into two types – primary and secondary amenorrhea.
Primary Amenorrhea - Primary amenorrhea occurs when a woman has not yet had her first menstrual period by the age of 16. This delayed period is usually due to late puberty, most common in teenage girls who are either very thin or very athletic. When young women are underweight, their bodies have yet to experience the normal puberty-related rise in body fat that sparks off the beginning of menstruation. On the other hand, the delay of menstruation may also be as a result of abnormal female reproductive organs or a genetic disorder involving the sex chromosomes such as Turner’s syndrome.
Secondary Amenorrhea - Secondary amenorrhea is a condition in which a woman who previously had normal, regular menstrual cycles experiences irregular or absent periods.
Amenorrhea affects 2% to 5% of all women of childbearing age in the United States. Secondary amenorrhea can affect all women who have begun menstruating. Young women who are involved in sports where intense exercise is required like ballet, long distance running or gymnastics are more likely to be affected with amenorrhea.
Amenorrhea is a symptom in itself. Depending on the cause of amenorrhea, you may experience the absence of periods together with various symptoms of hormone imbalance such as breast milk secretions, headache, weight gain, acne, altered sex drive low libido, lowering of the voice, excessive hair growth on the face and body, and vision changes.
The diagnosis of amenorrhea is based on your medical history, physical examination as well as a pelvic examination. Your health practitioner has to rule out other menstrual disorders, medical conditions, as well as medications in order to determine a proper diagnosis of amenorrhea.
Whether you are pregnant or not has to also be determined - a woman has to have missed at least three consecutive menstrual cycles without being pregnant to be classified as having amenorrhea.
A young woman, 16 years of age or older who has not yet had her first menstrual period should be evaluated immediately so that an early diagnosis can be made and treatment started. In addition, other tests may be performed to determine the underlying cause of the absence of periods.
Tests for Amenorrhea
Blood and urine tests are able to detect the imbalances of female hormones caused by problems with the ovaries or pituitary gland. Additional tests may also be performed to check levels of thyroid and adrenal hormones.
Pelvic ultrasound uses sound waves to detect problems or abnormalities in the structure of your uterus and ovaries.
Progesterone challenge test is done to evaluate your estrogen status. You may be treated with the hormone, progesterone to see whether this brings about a menstrual period.
What Causes Amenorrhea?
There are several possible causes of primary and secondary amenorrhea and they include:
Certain ovulation or chromosomal abnormalities can cause the eggs involved in ovulation and menstruation to be prematurely depleted
The absence of a uterus or vagina, vaginal septum or imperforate hymen present since birth can also result in the absence of menstrual periods
The hypothalamus is a gland at the base of the brain that acts as the control center for the body and regulates your menstrual cycle. A disorder of the hypothalamus causing an absence of menstruation is known as functional hypothalamic amenorrhea. Strenuous exercise, excessive weight loss as a result of anorexia nervosa, bulimia or stress may also contribute to interference in the normal functioning of the hypothalamus.
The pituitary gland is also responsible for regulating the menstrual cycle. A tumor or invasive growth may hinder the pituitary gland’s ability to perform this function.
Females who are obese often experience amenorrhea as a result of excess fat cells interfering with the process of ovulation.
An underactive thyroid causing hypothyroidism or an overactive thyroid causing hyperthyroidism may also be responsible for absent menstrual cycles.
Pregnancy is the most common cause of amenorrhea in women of reproductive age. Women do not ovulate when they are pregnant, thus menstruation stops.
Often contraceptives such as birth control pills or hormonal injections can interfere with the menstrual cycle. If oral contraceptives are discontinued, regular ovulation and menstruation may take between 3-6 months to resume.
Athletes or women who participate in strenuous training such as gymnastics, ballet or long distance running can experience absent menstrual cycles. There are many factors such as stress, low body fat and increased energy expenditure that contribute to athletes not having their periods
Medical conditions such as traumatic brain injury; brain, ovary, or adrenal gland tumors; ovarian cysts; overproduction of prolactin by the pituitary gland; hypothyroidism and hyperthyroidism, chronic illness; and Asherman's syndrome (scarring of the uterine lining caused by infection or surgery) can also cause secondary amenorrhea
Menopause that occurs before age 40 is considered premature menopause. It is also associated with secondary amenorrhea and may result from genetic factors or an autoimmune disease.
Polycystic ovarian syndrome (PCOS) is a disorder associated with hormonal imbalances and may also result in a loss of periods, obesity, acne and at times excess facial hair.
Other causes of secondary amenorrhea may be related to breastfeeding, physical and emotional stress, depression, certain medications, malnutrition, or sudden weight loss or weight gain.
Help for Amenorrhea
There are various treatment options depending on the cause to relieve the symptoms of amenorrhea and bring about a healthy, regular menstrual cycle. Depending on your overall health, medical history, age, and the extent of your condition, medications, procedures or therapies may used to treat amenorrhea.
Common medications such as non-steroidal anti-inflammatory drugs, birth control pills and hormone replacement therapy can help to encourage normal, regular menstrual cycles - although these medications have the potential risk of side effects. In addition, dietary modifications that include increased caloric and fat intake may also be beneficial.
More Information on Amenorrhea
Reducing the Risk of Developing Menstrual Disorders
If you are overweight or underweight, try to maintain a healthy weight and level of body fat by making appropriate changes to your diet and exercise routine.
Often, being underweight or overweight can cause menstrual disorders. Consult a doctor or dietician to help you make necessary adjustments to ensure a balanced diet.
Eat healthily and incorporate lots of vegetables, fruit, carbohydrates and protein into your diet. Reduce your intake of saturated fats, refined sugar, salt and caffeine.
Exercise regularly by walking, swimming, cycling or doing yoga. However, it may be necessary to reduce your exercise routine if it is excessive – some women exercise compulsively because they may fear weight gain while others who are athletes also struggle to cut back.
If you feel that your eating is compulsive and out of control, you should also be assessed for eating disorders. Eating disorders such anorexia nervosa and bulimia nervosa often contribute to amenorrhea.
Increase your intake of vitamins by taking vitamin B6, calcium and magnesium supplements to relieve cramping and PMS symptoms.
Reduce stress, levels by relaxing and resting more. Practice relaxation techniques such as meditation, deep breathing, progressive relaxation, biofeedback and yoga to quiet the mind and relax muscles. Detox and body cleansing can also be beneficial to help balance body systems.
Limit alcohol consumption and stop smoking naturally, as both habits can cause problems with your menstrual cycle.