Amenorrhea means absent or no menstrual periods.
What is amenorrhea?
Amenorrhea is considered a menstrual condition and there are 2 types.
Amenorrhea can be primary or secondary.
Primary amenorrhea is the term used when a young woman has never had a period. Most girls get their periods between 9 and 15 years old or about 2 to 3 years after they start their breast development.
Secondary amenorrhea is a term used when a young woman has had a period before, but stops having them. For example, your periods were regular for the first 2 years after you started having them, and now they don’t come at all. Or you only have 2 or 3 periods a year and sometimes 6 months goes by without a period.
What causes amenorrhea?
There are many possible causes of amenorrhea, including the following:
Pregnancy – If a female is sexually active and she doesn’t use contraception, or if her method of contraception has failed, amenorrhea can mean that she is pregnant.
Changes in weight – Girls who lose or gain a lot of weight may have no periods or skip periods because she does not have the right balance of foods to keep her body healthy.
Disordered eating – Many girls will develop amenorrhea if they are too thin (low BMI), have anorexia nervosa, bulimia, or other disordered eating such as using vomiting or excessive dieting to control weight.
Exercise – Girls who participate in sports such as running or gymnastics or in activities such as ballet often have athletic amenorrhea. This can be due to low weight, weight loss, or stress. Even an athlete whose weight is normal may not be taking in enough nutrition to keep her body healthy and may skip periods.
Polycystic Ovary Syndrome (PCOS) – Girls with PCOS typically have irregular menstrual cycles and excess hair growth or acne. They are often overweight. Girls with PCOS may have no periods (amenorrhea) or irregular periods, such as fewer than 9 periods a year or 3 or more months going by without a period.
Obesity – Being more overweight makes a girl more likely to have irregular menstrual periods.
Endocrine problems – Low or high thyroid hormone, too little or too much adrenal hormones such as cortisol, and too much prolactin, a hormone secreted by the pituitary gland in the brain, can cause irregular periods or amenorrhea. High prolactin levels can also be caused by medications such as risperidone.
Chronic illness – Girls with many diseases such as Crohn’s disease, celiac disease, cystic fibrosis, sickle disease, lupus, diabetes, and others may have irregular menstrual periods or amenorrhea because of low weight, stress, or a flare in their illness.
Medications and herbs – Some medications can cause amenorrhea. Be sure to tell your health care provider about ALL the medications and/or over-the-counter supplements and herbs that you take.
Ovary problems – Sometimes the ovaries do not make enough estrogen to cause periods because of a genetic problem such as Turner syndrome, previous radiation or chemotherapy to treat a tumour, lack of enough follicles in the ovary for the teen and adult years, and many other reasons. The condition is called primary ovarian insufficiency and is treated with hormones to replace the estrogen that the ovaries normally make.
Congenital anomalies of the reproductive tract – A birth defect such as an underdeveloped or absent uterus (the organ where menstrual blood comes from) can cause lack of periods. Although rare, if a teen girl is 15 or older or started her breast development 3 years ago and doesn’t have her period yet, a congenital anomaly may be considered and an ultrasound may be ordered by her health care provider to see if the uterus has developed.
Birth control (intrauterine devices, implantable rod, depot shot, continuous pill) – Some birth control methods make you more likely to have no periods or skip periods. This is a normal side effect of these medications (and is why some women prefer these types of birth control). You should talk to your doctor if you are concerned about pregnancy or amenorrhea on birth control.
Many girls will skip an occasional period if they have just started their periods, or are stressed or ill, but regular periods are sign that you are healthy and making enough oestrogen to keep your bones strong. So if you’re skipping periods, it’s important to find out why and whether you need treatment. Make sure that you take in 1300 mg of calcium and 600 units vitamin D per day, which is the equivalent of about 3-4 glasses of milk or 5-6 cups of cooked greens. Other dietary sources of calcium include fortified tofu, fortified orange juice, and yogurt.
How is amenorrhea diagnosed?
Not having a period for more than a couple of months may not be normal, and finding out why is important. Amenorrhea may be completely normal if you are on birth control, but you should check with your health care provider if this is an expected side effect of you chosen form of birth control. Diagnosis starts with having a pregnancy test and a medical evaluation by a health care provider (HCP).
The exam begins with reviewing your medical history.
Does it matter if you skip periods?
Many girls will skip an occasional period if they have just started their periods, or are stressed or ill, but regular periods are sign that you are healthy and making enough estrogen to keep your bones strong. So if you’re skipping periods, it’s important to find out why and whether you need treatment. Make sure that you take in 1300 mg of calcium and 600 units vitamin D per day, which is the equivalent of about 3-4 glasses of milk or 5-6 cups of cooked greens. Other dietary sources of calcium include fortified tofu, fortified orange juice, and yogurt.
What is the treatment for amenorrhea?
Treatment depends upon the cause of the amenorrhea.
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