Amenorrhea

Amenorrhea

Amenorrhea
Amenorrhea is characterized by a complete lack of menstrual cycles. This may appear as primary amenorrhea, which is the lack of menstruation before age 16. Secondary amenorrhea occurs in women who have had normal menstrual cycles that have stopped for six months or more. A very long list of reasons exists for amenorrhea, and a doctor will run multiple tests to diagnose the cause. Amenorrhea can be treated with drugs and/or surgery. Sometimes amenorrhea can be remedied if you make changes to your lifestyle habits like taking care of your mental health and/or getting to a healthier weight. If you experience the symptoms of amenorrhea, contact a doctor for further advice.

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    A OBGYN (Obstetrics & Gynecology), answered on behalf of
    Is it normal to not have a period for several months?
    Women who don't menstruate for several months are defined as having amenorrhea. In this video, Darcy Bryan, MD, of Riverside Community Hospital, explains possible causes of this condition.
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    Some women experience the absence of menstrual periods or extremely light periods; this is called amenorrhea. Primary amenorrhea is the condition of never having had a period by the latest age at which menstruation usually starts (age eighteen). Secondary amenorrhea is the cessation of menstruation after at least one period. Some causes of amenorrhea are pregnancy; menopause; breast-feeding; heavy athletic training; emotional factors; stress; previous use of birth control pills; excessive dieting or anorexia; starvation; use of some drugs; a congenital defect of the genital tract; hormone imbalance; cysts or tumors; chronic illness; and chromosomal abnormalities. Often, amenorrhea is caused by a combination of several of these factors. Since amenorrhea is a frequent symptom of infertility, medical textbooks and practitioners pay considerably more attention to it than to premenstrual changes or painful periods, although the latter two are far more common.

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    Because menstruation is a necessary bodily function in women, amenorrhea is usually a symptom rather than a disease in itself. A lack of menstrual period for a few months usually indicates pregnancy, as the uterine lining remains to provide nutrition to the fertilized egg. Primary amenorrhea is usually caused by a birth defect affecting the reproductive system, a genetic disorder, or disrupting of the pituitary gland's function. Secondary amenorrhea can be caused by the following situations:
    • Hormone-based contraceptives, including oral medication, injections, or those containing progesterone, can disrupt the menstrual cycle for up to six months after use.
    • Hormonal disorders, such as polycystic ovary syndrome. This disorder is indicated by an imbalance of estrogen and the male hormone androgen, and can cause facial hair, amenorrhea or overly heavy menstruation, and obesity.
    • Uterine scarring (otherwise known as Asherman's syndrome) from surgery or infection.
    • Premature menopause (also known as primary ovarian insufficiency), in which a woman's supply of eggs diminishes before age 40.
    • Eating disorders, such as anorexia or bulimia, cause abnormally low body weight and disrupt the body's balance of hormones.
    Other drugs, such as antidepressants, chemotherapy, hallucinogenic drugs, or cocaine.
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    The treatment options for amenorrhea depend on its cause. For some women, treatment consists of healthy lifestyle changes geared toward maintaining a healthy weight, managing stress, or regulating physical activity. Others may need a prescription for oral contraceptives in order to regulate a hormonal disorder such as polycystic ovary syndrome (PCOS). If the amenorrhea was caused by a tumor, it can be removed surgically. Other causes such as genetic disorders may not have treatment. Girls under 16 who have primary amenorrhea will be checked regularly for signs of puberty such as breast development and bodily hair. They can also be prescribed hormones such as progestin or estrogen to help kick-start their menstrual cycle and promote the effects of puberty.
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    Secondary amenorrhea may be prevented if it is caused by excessive exercise, being over- or underweight, or use of certain medication. Excessive exercise or training, like gymnastics and cross-country, can cause your body to stop menstruating due to low body weight and high caloric expenditure. By reducing the amount of exercise or avoiding certain training you may be able to prevent secondary amenorrhea.

    Being drastically over- or underweight can often lead to secondary amenorrhea and is typically a preventable condition. Certain medications, like birth control and anti-depressants, may cause secondary amenorrhea. It may be possible to avoid or change certain medications that would have an affect on your menstrual cycle, therefore preventing secondary amenorrhea.

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    The symptoms of amenorrhea vary depending on its cause. Often, amenorrhea has little to no other symptoms. But if the cause is related to a hormonal imbalance, symptoms of amenorrhea can include: excess facial hair, a deeper voice, acne, hot flashes, nipple discharges, visual problems, or vaginal dryness. Primary amenorrhea is defined as an absence of menstruation by the age of 16. Usually, secondary amenorrhea is indicated by a lack of menstruation for at least three to six months.

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    The causes of amenorrhea can be determined through a number of tests. A pregnancy test will indicate if the absence of menstruation signifies an abnormality in the body, rather than the natural amenorrhea in pregnancy or breastfeeding women. Primary amenorrhea is diagnosed by checking for other results of puberty such as breast development and bodily hair. To diagnose secondary amenorrhea, doctors ask about the regularity of previous menstruation cycles, medication, nutritional or exercise habits, and family history. Pelvic exams can be done to check for problems with the reproductive organs such as tumors. Other imaging tests like magnetic resonance imaging (MRI) or ultrasound can also detect tumors or growths. Furthermore, blood tests can check for hormonal imbalances by measuring both estrogen and androgen levels in the blood. Finally, doctors can prescribe a hormone medication called progestogen, which can determine if a lack of estrogen is the cause of amenorrhea.

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    Because amenorrhea can be caused by a number of conditions, several risk factors must be considered. Undernourishment, eating disorders, or low body fat put you at risk for amenorrhea or the absence of menstrual periods and can cause other medical complications. Excessive or over-strenuous exercise can also stress both your hormonal and reproductive systems and lead to amenorrhea. If you take drugs such as contraceptives or antidepressants, you run the risk of menstrual irregularities. Also, if you have had uterine surgery such as dilation and curettage (D&C), a cesarean section or a removal of uterine fibroids, you may develop Asherman's syndrome, in which scarred uterine tissue accumulates in the uterus and can block regular menstruation.
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    Menstrual irregularities can be normal for the first few years of menstruation following puberty, but amenorrhea can signify a more serious condition or disorder. Adolescents with abnormal cycles for three months between periods should be assessed. Sometimes stress or illness can cause amenorrhea and your menstrual cycle can return to normal by itself. But if you cannot resume your regular menstrual cycle after six months, contact your primary care physician or gynecologist, who can help you determine the cause of your amenorrhea and begin treatment. Some women whose menstruation cycles tend to be irregular might not be alarmed until six months of amenorrhea, but some women who are usually very regular may want to see a doctor after three months have passed. If you are sexually active and generally healthy, you may be pregnant and you should see your primary care physician as soon as possible. Make sure you are armed with a record of your usual cycle, a list of any medications and dosages you take, and your general medical history when you see your doctor so you can be best diagnosed.
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    Amenorrhea can be further classified into ovulatory amenorrhea (when an egg is released) and anovulatory amenorrhea (when an egg is not released). Most women are diagnosed with anovulatory amenorrhea because the release of an egg can be obstructed by a number of situations. Ovulatory amenorrhea usually occurs when a defective fertilized egg or its placenta create a tumor in the uterus. Amenorrhea can also be classified by the location of the problem in the reproductive system or the type of disorder causing it, including: autoimmune, hormonal, genetic, structural, or stress.