Amenorrhea – Is it normal to have Amenorrhea?
The absence of menstrual bleeding in a woman of reproductive age is called amenorrhea. The incidence of primary amenorrhea in the United States is less than 1%. According to the WHO, approximately 5-7% of menstruating women in the USA experience 3 months of secondary amenorrhea. Amenorrhea can be classified as Primary, means there is absence of menstruation by the age of 16 or Secondary i.e. absence of menstrual periods for three or more months in a woman who was previously menstruating.
Primary amenorrhea is generally a result of anatomical, genetic or inborn abnormalities in young women. These lead to failure of development of menstrual cycle and, therefore, inability to get pregnant. Conditions like gonadal dysgenesis, where ovaries are prematurely depleted of follicles and oocytes (egg cells), lead to premature failure of the ovaries and are one of the most common causes of primary amenorrhea in young women. Conditions like polycystic ovarian syndrome, Turner syndrome and androgen insensitivity syndrome are other causes for primary amenorrhea.
The most obvious cause of secondary amenorrhea is pregnancy. The other causes, apart from pregnancy, are hormonal disturbances in the hypothalamus and pituitary gland by severe illness, extreme stress, and rigorous exercise or in some cases of tumors.
Other than absence of menstrual cycle, the other symptoms of amenorrhea depending on their causes are as follows:
- Milky nipple discharge
- Hair loss
- Changes in vision
- Excess facial hair
- Pelvic pain
- Change in breast size
- Weight gain or weight loss
- Vaginal dryness
- To rule out pregnancy as a cause of amenorrhea, proper pregnancy tests should be conducted.
- Blood tests can also be done to check hormone levels including testosterone, FSH, LH, TSH, and Prolactin.
- Other investigations like, CT scan or MRI to check for tumors, genetic tests (Karyotyping), and pelvic ultrasound along with other physical examinations to check for birth defects of the vagina and the uterus are highly recommended.
- The choice of treatment for amenorrhea depends upon its underlying causes. Lack of periods caused due to birth defects may be treated by hormonal therapies and/or surgery.
- In cases where amenorrhea is caused by a tumor in the brain, surgery and/or radiation exposure as well as medicines may be helpful.
- If sedentary lifestyle is the underlying cause for amenorrhea leading to excessive weight gain, then the menstrual cycle can be reversed and regulated by maintaining a healthy lifestyle.
- Similarly, when extensive exercise is the cause, it can be reversed by adequate physical exercise.
- Stress management programs can be prescribed.
- The best way to prevent 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.
- Avoidance of alcohol overconsumption can also be quite effective to ward off amenorrhea.
- Parents of teenage girls should always keep a check on the growth and development of secondary sexual characteristics in their girl child at an early age, a preset of Menarche, which can help reduce the burden of the disease through early detection and treatment.
Divya Naik, M.Sc (Biomedical Genetics), Department of Biomedical Genetics, Vellore Institute of Technology (VIT), Vellore, India.
February 13, 2018
- Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment.American Family Physician. 73, 1374−1382. Retrieved April 6, 2012, from http://www.aafp.org/afp/2006/0415/p1374.html