• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

AMENORRHEA TYPES, CAUSES, AND TREATMENT

Amenorrhea is a condition in women that implies the absence of menstrual periods during the reproductive age – after puberty and before menopause. Amenorrhea is a not a disease though it is a health disorder that might have serious complications and must be treated with care. That said, it does not necessarily indicate infertility in women. Generally, women menstruate once a month beginning from the age of 13-14 years and continuing until 50 years of age – when women experience menopause. Also, during conditions such as pregnancy and breastfeeding, menstruation stops temporarily. Still, in other cases, when women do not get their periods for a specific time – the condition is referred to as Amenorrhea.

Types of Amenorrhea

There are two basic types of amenorrhea, namely:

Primary Amenorrhea: This condition occurs when a woman does not start having periods during puberty, i.e., if the periods do not begin by the age of 16 years, medical help should be taken. 

Secondary Amenorrhea: This condition occurs when a woman has periods, but then they cease to occur. However, the condition is normal during pregnancy and breastfeeding, but when it occurs irrespective of these two factors, it is referred to as secondary amenorrhea. A woman who has secondary amenorrhea, used to have regular periods but then does not have any period for 3 months or in other cases, used to have irregular periods but then does not have any for 6 months or more. 

Symptoms of Amenorrhea

The main symptom of amenorrhea is the absence of menstrual periods; however, other symptoms apart from this are:

  • Milky discharge from nipples
  • Headache
  • Excessive hair on the face
  • Pelvic pain
  • Acne
  • Changes in breast size
  • Weight Gain

In the case of primary amenorrhea, the woman can also experience lack of breast development.

Causes of Amenorrhea

Some of the underlying causes of amenorrhea are:

Natural Amenorrhea: Conditions such as pregnancy, breastfeeding and menopause cause natural amenorrhea.

Contraceptives: Women who take contraceptives may suffer from amenorrhea, even afterdiscontinuing of the birth control pills, it may some time for regular ovulation and menstruation to return.

Medications: Certain medicines, including antipsychotics, cancer chemotherapy, anti-depressants, blood pressure drugs, etc. – can cause periods to stop.

Lifestyle Factors: Lifestyle factors such asbelow hamper the regular periods:

  • Low body weight: Extremely low body weight disrupts hormonal functioning and problems in ovulation, leading to amenorrhea.
  • Excessive exercise: Low body fat, stress and high usage of energy by athletes and sportswoman make them more prone to amenorrhea. More so, rigorous training activities such as ballet also can cause amenorrhea.
  • Stress: Stress can alter the normal menstrual cycle by disturbing the hormones in the brain that regulate the menstrual cycle.
  • Depression: Depression can alter hormonal functioning, causing amenorrhea.
  • Poor Nutrition: Lack of adequate nutrition in the body can cause severe deficiencies resulting in menstrual problems.
  • Place and Weather change may also cause Amenorrhea.

Hormonal and Medical Problems: Some hormonal disturbances and medical issues can also cause amenorrhea, such as:

  • Polycystic ovary syndrome (PCOS): This problem causes high and sustained levels of hormones as compared to fluctuating hormonal level that is needed for regular periods.
  • Thyroid malfunction: An overactive and underactive thyroid gland causes menstrual irregularities.
  • Pituitary tumour: A benign tumour in the pituitary gland can cause hormonal imbalances leading to irregular menstrual cycles.
  • Premature menopause: Some women experience menopause before the age of 50 due to the diminishing ovarian supply of eggs.
  • High Prolactin hormone level also can cause amenorrhea.

Structural Problems

Some issues with sexual organs can also lead to amenorrhea, such as:

  • Uterine scarring: Scarring on the line of the uterus due to factors such as caesarean delivery, D&C and treatment of uterine fibroids, etc.prevents regular build-up and flaking of the uterine lining.
  • Absence of reproductive organs: Absence or improper development of reproductive organs since birth can cause menstrual problems.
  • Vaginal structural abnormality: Structural abnormality such as a membrane wall that blocks the outflow of blood, can lead to menstrual issues.

Risk Factors of Amenorrhea

Certain factors may increase the risk of amenorrhea in some women, such as:

  • Family history
  • Eating disorders
  • Rigorous and consistent physical exertion/training

Complications of Amenorrhea

Some problems that may arise because of amenorrhea include:

  • Infertility: Absence of menstrual cycles implies no pregnancy
  • Osteoporosis: Absence of menstrual cycles can lead to the weakening of bones, called osteoporosis.

Treatment of Amenorrhea

The basic treatment of amenorrhea depends on the underlying problem causing the condition. Some common treatment options include – medications, surgery, lifestyle changes, or all of these. Lifestyle changes include:

  • Maintaining a healthy weight
  • Controlled exercise
  • Reduction of stress
  • Eating a healthy diet

Surgery may be done to remove scar tissues in the uterus, cure genetic defects and eliminate the noncancerous pituitary tumour. Medications may be advised to control thyroid issues, premature ovary failure, and other hormonal issues etc.

That said, amenorrhea can be treated or managed if medical care is received timely; however, some cases might be beyond treatment and can suffer from related complications.

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