5 February 2020

Amenorrhea: Causes, symptoms and treatment

Amenorrhea
Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London

 

Amenorrhea is a lack of menstruation – in simple terms, you don’t get periods. There are two types. Primary amenorrhea is when a teenager has not started her periods by the age of 16; secondary amenorrhea is when a woman has previously had periods in the normal way, but these have stopped for six months or more. In the case of primary amenorrhea, it can often be put down to differences in the speed of development. A delayed appearance of secondary sexual characteristics, as well as the start of periods, can frequently run in families and provided periods start by the age of 16, there is no cause for concern. Delayed development aside, there is little difference between the two types.

In this article we focus on the causes of amenorrhea and its symptoms, which can be many and varied, and the different types of treatment that may be recommended.

What are the causes of amenorrhea?

There are certain times in life when it is perfectly normal and natural to not have periods. These include the time of childhood before puberty, when you are pregnant or breastfeeding and after the natural menopause. Other than these non-problematic causes, there is a whole variety of reasons as to why the onset of periods can be delayed, or having started, they then stop. The possible reasons fall into three main categories, though in individual cases these could overlap. Broadly speaking, these are lifestyle factors, hormonal problems and certain medications.

Lifestyle factors connected with amenorrhea

  • Stress can have all sorts of effects on the body that appear unconnected to the cause. When you are stressed, periods can become irregular or stop completely. It’s easier said than done but avoiding stress through making sure that you have time to relax, exercising regularly and following a good balanced diet can all help to regularise your periods.
  • Sudden loss of weight can also cause your periods to stop. Whether the reason is overenthusiastic dieting or even anorexia, if your BMI falls below 18.5 for whatever reason, especially if the loss is sudden, periods can stop completely.
  • Being overweight can also play havoc with your menstrual cycle and cause effective infertility through lack of periods. This is because your body produces more oestrogen if you are overweight and this can have a detrimental impact on your periods. If you have a BMI over 30, it is likely to cause these problems. Ask your GP for a referral to a dietitian who can advise you on how to lose weight safely.
  • Extreme exercise can have a similar effect to extreme dieting. If you are dedicated to the gym, a runner or any kind of athlete, your body’s muscle to fat ratio can also have an effect on your hormonal balance, and hence your periods. If your periods have stopped and this is a problem, you should cut back to a more reasonable level of exercise and your reproductive system should return to normal.

Hormonal problems

A hormonal imbalance is often at the root of any period irregularities. These could be caused by:

  • Polycystic ovarian syndrome (PCOS) is the most common cause of amenorrhea in women. This condition consists of an ovulation disorder and evidence of androgen excess.
  • Thyroid gland malfunction, whether it is overactive or underactive, can cause irregularities in the menstrual cycle or even cessation of periods.
  • Premature menopause can occur from the age of around 40, rather than the age of 50 which is the norm. When this happens, it is because of an early depletion of the ovarian reserve and so ovulation and periods stop altogether.

Medications which can bring about amenorrhea

A number of drugs can cause a hormonal imbalance which shows itself in amenorrhea. These include some antipsychotics, medication for high blood pressure, chemotherapy and radiotherapy, antidepressants and allergy medicines.

Symptoms of amenorrhea

Apart from the most obvious symptom, the absence of periods, other symptoms can appear depending on whether the cause was hormonal, lifestyle-related or a result of medication. Possible symptoms include a milky discharge from the nipples, hair loss or excess facial hair, pain in the pelvis, headache or problems with vision.

What is the best treatment for amenorrhea?

Treatment would depend on the underlying cause of the condition, so the first step is to consult your GP. You may be referred to a counselling service or dietitian if the problem appears to arise from stress or being over or underweight, or you could be referred to a gynaecologist or endocrinologist if the problem is more to do with a hormonal imbalance or physical factors. You will probably need a full gynaecological examination and you could also be referred for an ultrasound scan and blood tests.

Medications may be prescribed if the lack of periods is caused by irregularities in the pituitary or thyroid glands. If there is another underlying condition such as PCOS causing the lack of periods, you could be prescribed either the contraceptive pill or medication containing progesterone. These therapies can bring the menstrual cycle back to normal. If the cause is early menopause, hormone replacement therapy may be recommended.

Finding out how IVI can help

The main impact of amenorrhea is that it causes infertility. Since the menstrual cycle is centred on ovulation – that is, the release of an egg that can potentially be fertilised – if periods cease you are certainly not ovulating. If you have concerns about your fertility as a result of amenorrhea or even a disrupted or irregular menstrual cycle, it can be very helpful for your peace of mind to discuss the issue with a fertility specialist. You need to know whether your condition is treatable and what your options are.

If you would like to know more about the treatments and services we offer, do take a look at our website; it is always up to date with the latest news and developments in the world of infertility treatments and assisted reproduction. Once you decide to get in touch, it’s as simple as completing our online contact form, or you can give us a call on our Freephone number: 0800 52 00 161.

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