Amenorrhea Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

Amenorrhea Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

What is amenorrhea?

Amenorrhea is the medical term for the absence of menstrual periods, either on a permanent or temporary basis. Amenorrhea can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.

Amenorrhea Causes, Symptoms, Diagnosis, Treatment, Prevention, Home Remedies

The menstrual cycle can be influenced by many internal factors such as transient changes in hormonal levels, stress, and illness, as well as external or environmental factors. Missing one menstrual period is rarely a sign of a serious problem or an underlying medical condition, but amenorrhea of longer duration may signal the presence of a disease or chronic condition.

There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea. Primary amenorrhea is the absence of a first period in a young woman by the age of 16. Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period.

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What causes amenorrhea?

Amenorrhea can be caused by any number of changes in the organs, glands, and hormones involved in menstruation.

Primary amenorrhea causes

Possible causes include:
  • Failure of the ovaries (female sex organs that hold eggs)
  • Problems in the nervous system or the pituitary gland (a gland in the brain that makes a hormone involved in menstruation)
  • Poorly formed reproductive organs
In many cases, the cause of primary amenorrhea is not known.

Secondary amenorrhea causes

Common causes of secondary amenorrhea are:

  • Pregnancy
  • Breast feeding
  • Cessation of birth control pills
  • Menopause
  • Some birth control methods, such as Depo Provera
Other causes of secondary amenorrhea include:

  • Stress
  • Poor nutrition
  • Depression
  • Certain drugs/medications
  • Extreme weight loss
  • Over-exercising
  • Ongoing illness
  • Sudden weight gain or being very overweight (obesity)
  • Problems with hormone-making glands, including the thyroid (rare)
  • Tumors on the ovaries (rare)
  • Prior uterine surgery with scarring
A woman who has had her uterus or ovaries removed will also stop menstruating.

Post-pill amenorrhea

Women who have stopped taking oral contraceptive pills should experience the return of menstruation within three months after discontinuing pill use. Previously, it was believed that birth control pills increased a woman's risk of amenorrhea following use of the pill, but this has been proven not to be the case. Women who do not resume menstruation after three months have passed since oral contraceptive pills were stopped should be evaluated for causes of secondary amenorrhea.

How can I know if I have amenorrhea?

If you miss your period, contact your health care provider. First, he or she will want to know if your period has stopped because of a normal condition such as pregnancy or menopause. (Most women go through menopause in their early 50s.) You will be given a physical and pelvic exam, and will be asked about your medical history. You will also be asked to describe your symptoms. A sample of blood and urine may be taken for testing.

In some cases, finding the cause of amenorrhea can be difficult. You can help your health care provider by keeping a record of changes in your menstrual cycle with a menstrual calendar. Note how long your periods last and when you had your last period. Also, report any drugs you are taking and changes in your diet and/or exercise program. You should also report any emotional problems you are having, including stress.

What are the symptoms of amenorrhea?

Primary or secondary amenorrhea (respectively) is considered to be present when a girl has:

  • not developed menstrual periods by age 16; or
  • a woman who has previously had a menstrual cycle stops having menstrual periods for three cycles in a row, or for a time period of six months or more and is not pregnant.
Other symptoms and signs may be present, which are highly variable and depend upon the underlying cause of the amenorrhea. For example, symptoms of hormonal imbalance or male hormone excess can include irregular menstrual periods, unwanted hair growth, deepening of the voice, and acne. Elevated prolactin levels as a cause of amenorrhea can result in galactorrhea (a milky discharge from the nipples that is not related to normal breastfeeding).

When to see a doctor

Consult your doctor if you've missed at least three menstrual periods in a row, or if you've never had a menstrual period and you're age 16 or older.

Complications of amenorrhea 

Complications of amenorrhea may include:

  • Infertility. If you don't ovulate and have menstrual periods, you can't become pregnant.
  • Osteoporosis. If your amenorrhea is caused by low estrogen levels, you may also be at risk of osteoporosis — a weakening of your bones.

How is amenorrhea diagnosed?

The diagnosis of amenorrhea requires a careful medical history to document the presence of amenorrhea as well as any other coexisting medical conditions that may be the cause of amenorrhea. A physical examination, including a pelvic examination is also performed.

Depending upon the results of the history and physical examination further diagnostic tests may be ordered. Blood tests may be ordered to examine the levels of ovarian, pituitary, and thyroid hormones. These tests may include measurements of prolactin, follicle-stimulating hormone (FSA), estrogen, thyrotropin, dehydroepiandrosterone sulfate (DHEA-S), and testosterone. For some individuals, a pregnancy test is the first test performed.

Imaging studies, such as ultrasound, X-ray, and CT or MRI scanning may also be recommended in certain individuals to help establish the cause of amenorrhea.

How is amenorrhea treated?

Amenorrhea due to normal causes, such as pregnancy, does not need to be treated. In other cases, treatments will depend on the cause. Treatments include:

In some women, nutritional deficiencies induced by dieting can cause amenorrhea. Such women should eat a properly balanced diet.

In some women, excessive body weight could be the cause of amenorrhea. These women should restrict the amount of fat in their diet, and they should exercise moderately to maintain an ideal body weight.

More than 8 hours of vigorous exercise a week may cause amenorrhea. A moderate exercise program may restore normal menstruation.

If amenorrhea is caused by emotional stress, finding ways to deal with stress and conflicts may help.

Maintaining a healthy lifestyle by avoiding alcohol consumption and cigarette smoking is also helpful.

Hormones, ordered by a health care provider

Surgery (rarely)

Amenorrhea may be the symptom of anorexia nervosa, a serious eating disorder. If you or someone you care about has this condition, get help right away.

When should I see my health care provider?

See your health care provider if you:

  • Miss a period
  • Have trouble with your balance, coordination, or vision
  • Begin producing breast milk, although you have not given birth
  • Have excessive body hair growth
  • Are over age 16 and haven't had your first period

How can I prevent secondary amenorrhea?

The best way to prevent secondary amenorrhea is to maintain a healthy lifestyle. Stay at a healthy weight, learn ways to cope with stress and emotional problems, and stay up to date with your scheduled pelvic exam and Pap smears.

Home remedies for Amenorrhea

Some lifestyle factors can cause amenorrhea, so strive for balance in work, recreation and rest. Assess areas of stress and conflict in your life. If you can't decrease stress on your own, ask for help from family, friends or your doctor.

Be aware of changes in your menstrual cycle and check with your doctor if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts and any troublesome symptoms you experience.

Amenorrhea Prognosis

Amenorrhea is typically not a life-threatening condition. The prognosis for amenorrhea depends upon the underlying cause and the type of treatment that is available. For most women, medications, lifestyle changes, or surgery can correct amenorrhea.

Amenorrhea has been associated with reduced bone density and increased fracture rates