Amenorrhea – Symptoms and Causes
Overview
Amenorrhea is a condition where menstrual periods are absent. It comes in two main types.
Primary amenorrhea happens when someone hasn’t had their first period by age 15. This often stems from hormone imbalances or anatomical issues.
Secondary amenorrhea occurs when someone who previously had regular periods misses three or more consecutive cycles. Pregnancy is the most common reason for secondary amenorrhea, though hormonal problems can also cause it.
The treatment approach for amenorrhea varies based on what’s causing it. Healthcare providers typically look for underlying factors before recommending specific treatments.
Signs and Symptoms
Amenorrhea can appear with several other symptoms. These may include:
- Milk-like discharge from nipples
- Hair thinning
- Head pain
- Changes in vision
- Increased facial hair growth
- Pain in the pelvic area
- Skin breakouts
When to Seek Medical Attention
It’s important to contact your healthcare provider if you have not had a period for three consecutive months. You should also make an appointment if you have reached age 15 and have not yet started menstruating.
These situations require medical evaluation to determine the cause and appropriate treatment.
Why Periods Stop
Natural Causes
Most women experience times without periods during their lives. Pregnancy is a common cause, as the body naturally stops menstruation while carrying a baby.
Similarly, when breastfeeding, many women don’t have periods because of hormonal changes that support milk production. Later in life, menopause marks the permanent end of menstruation, typically around age 50.
Birth Control Methods
Many birth control options can stop or change periods. Some women using birth control pills have lighter periods or no periods at all. After stopping the pill, it might take several months for regular periods to return.
Other contraceptives that may cause periods to stop include:
- Hormonal implants
- Injectable contraceptives
- Some intrauterine devices (IUDs)
Medicine Effects
Several types of medications can interrupt the menstrual cycle. These include:
| Medication Type | How It May Affect Periods |
|---|---|
| Antipsychotics | Can alter hormone balance |
| Chemotherapy | May damage ovaries temporarily or permanently |
| Antidepressants | Some types affect hormone regulation |
| Blood pressure medications | May disrupt normal cycle |
| Allergy drugs | Some can affect hormone levels |
Lifestyle Influences
Daily habits and physical condition can strongly affect menstruation.
- Weight Issues: When body weight drops too low (about 10% under normal weight), the body may stop ovulation to conserve energy. This commonly happens with eating disorders like anorexia and bulimia.
- Heavy Exercise: Activities requiring intense training such as ballet, competitive running, or gymnastics can halt periods. This happens due to low body fat, high energy use, and physical stress.
- Mental Stress: High stress levels can temporarily disrupt the brain’s hormone control center (hypothalamus). When stress decreases, periods usually return.
Hormone Problems
The delicate balance of hormones can be disrupted by several conditions:
- Polycystic ovary syndrome (PCOS) causes consistently high hormone levels rather than the normal fluctuations needed for menstruation.
- Thyroid issues, both overactive and underactive, can stop periods.
- Pituitary tumors (non-cancerous) may interfere with hormones that regulate menstruation.
- Early menopause occurs when the egg supply runs out before age 40, ending periods permanently.
Physical Abnormalities
Physical problems with reproductive organs can prevent periods:
Uterine scarring (Asherman’s syndrome) may develop after procedures like D&C surgeries, C-sections, or fibroid treatments, preventing the normal build-up and shedding of the uterine lining.
Missing reproductive organs due to development issues before birth can mean some women are born without a fully formed uterus, cervix, or vagina.
Vaginal blockages like membranes or walls can prevent menstrual blood from flowing out, though ovulation and menstruation may still occur internally.
Risk Factors
Several factors can raise the chance of developing amenorrhea:
Family History: Women whose relatives have had amenorrhea may be more likely to experience it themselves due to genetic factors.
- Eating Disorders: Conditions like anorexia or bulimia significantly increase the risk.
- Intense Exercise: Women who participate in rigorous athletic training programs face a higher chance of missed periods.
Previous Gynecologic Procedures: Certain medical interventions such as D&C (especially after pregnancy) or LEEP procedures can increase the likelihood of amenorrhea.
These risk factors don’t guarantee someone will develop amenorrhea, but they do make it more likely to occur.
Complications
When someone stops having periods, this can lead to several health problems. These issues can affect both physical and mental health.
Fertility Issues
Not having menstrual periods means a person isn’t ovulating (releasing eggs). Without ovulation, pregnancy can’t happen naturally. Hormone imbalances that cause missed periods can also lead to:
- Trouble getting pregnant
- Higher risk of miscarriage
- Other pregnancy complications
Emotional Impact
Missing periods can create stress, especially for young people. Teens and young adults may feel different from their peers who are having regular cycles. This can affect self-esteem and cause worry about future fertility.
Bone and Heart Health Risks
Low estrogen levels often play a role in amenorrhea. This hormone shortage can lead to:
- Osteoporosis – bones become weak and break more easily.
- Cardiovascular problems – including issues with heart muscle and blood vessels.
These health risks may not show symptoms right away but can cause serious problems over time.
Physical Discomfort
When structural problems cause amenorrhea, pain often follows. Pelvic pain may range from mild to severe depending on the underlying condition.
The good news is that most complications can be prevented or treated once the cause of amenorrhea is found. Early medical care is important to reduce these risks.
