Any woman who stops seeing her menses for a number of cycles, is said to be experiencing what is known as Amenorrhea. Women who have not yet reached menopause usually have their menstrual cycle lasting between 21 to 35 days. During this period, it is normal if your menstrual flow continues for about 2 to 6 days. The only time it is expected for a woman not to see her period is during pre-puberty age, when she is pregnant and when she has entered into her menopausal age. If you don’t fall in any of these categories and you are not seeing your menses at all or infrequently as it should be, you should try to see your doctor to check out what might be causing your absent menstruation.
Amenorrhea is a symptom with many potential causes and is simply noticed as the absence of menstrual cycle. This condition has been categorised into 2 as primary amenorrhea and Secondary amenorrhea.
Primary Amenorrhea is described as when a girl is supposed to have had her first menstruation but hasn’t. Normally a girl is expected to have seen her first menses (menarche) before 15 years and should have started developing other secondary sexual characteristics like breasts. If for any abnormal reasons menstruation is delayed in the girl, it can be diagnosed as primary amenorrhea.
Secondary amenorrhea, on the other hand, refers to the absence of menstruation for 3 consecutive cycles or 6 months in a woman who previously had regular menses. It is also defined as the absence of menstruation for 12 months in a woman with history of infrequent menstruation (also called oligomenorrhea).
Ten Reasons Why A Woman Can Stop Seeing Her Period?
Some of the things that can increase the risk for a woman to stop seeing her period (amenorrhea) include :
- Having someone else in your family with history of amenorrhea.
- When you have eating disorders such as anorexia nervosa or bulimia.
- Women involved in athletics and vigorous exercises.
In addition, there are several other reasons why a woman can stop seeing her menses. Here are ten possible causes of amenorrhea in women to look out for :
- Natural causes – including pregnancy, breastfeeding and menopause or pre-puberty.
- Lifestyle factors – like excessive exercise, stress and low body weight can interrupt hormonal functions resulting in Amenorrhea.
- Developmental defects – especially of the lower genital tract like the occlusion of the hymen, vagina or cervix can result in absent menstruation.
- Embryological abnormalities –developmental defects of the upper genital tract including the uterus. E.g syndrome of gonadal dysgenesis, pseudo Turner syndrome, testicular feminization syndrome, and female pseudohemaphroditus.
- Uterine and endometrial causes – like tuberculous suppuratitve endometritis and Asherman’s syndrome (trauma to endometrium).
- Ovarian failure – this can cause premature menopause. Ovarian tumours and other ovarian abnormalities like polycystic ovarian syndrome can cause menstruation to stop.
- Non-gonadal endocrine diseases – like thyroid disease (hyperthyroidism or hypothyroidism), diabetes mellitus, and adrenal diseases such as cushing’s syndrome and congenital adrenal hyperplasia.
- Hypothalamic diseases – like pseudo cyesis, and persistent corpus luteum syndrome can cause Amenorrhea.
- Pituitary causes – like galactorrhea-amenorrhea syndrome, primary and secondary hypopituitarism.
- Drug induced Amenorrhea – This results from contraceptive use and other medications including antipsychotics, antidepressants, cancer chemotherapy, allergy and blood pressure drugs.
What You Should Do
If you or your teenage daughter is having absent menstruation, it is important to see your doctor for proper diagnosis of the reasons behind it. The parameters used for the clinical diagnosis of amenorrhea to ascertain the exact cause involves several things. Comprehensive history taking of the patient including menstrual history, medical and surgical history, growth and nutrition history, drug history, family history and social history is the first step towards obtaining a clinical diagnosis of the possible cause of Amenorrhea you may be experiencing.
Your doctor will also need to carry out a very detailed general head to toe physical examination involving inspection and palpation for possible organo-metabolic causes of Amenorrhea as well as pelvic examinations to rule out genital tract causes.
In addition, there may be need to use laboratory investigations to corroborate clinical findings. Your doctor might ask you to go for Laboratory tests like pregnancy test, thyroid function test, ovarian function test, prolactin test and testosterone tests are. The use of imaging studies such as ultrasound scan, CT scan, MRI, laparoscopy and hysteroscopy have been very helpful to the diagnostic process.
How is it Treated?
The management of amenorrhea in women is directed to and dependent on the specific cause of the problem as diagnosed clinically by your doctor. There are a number of medical and surgical interventions that can be used to address each possible pathological reason why you are not seeing your menstrual period.
However, for the more simpler causes of amenorrhea, lifestyle changes in diet and exercise can bring about restoration of normal menstruation. In women whom estrogen levels are low, estrogen replacement is important to prevent loss of bone density. If estrogen and progesterone are given cyclically, normal menstrual rhythm will be restored.
- Medscape – “Amenorrhea “
- S. Campbell and A. Monga (2006),: Gynaecology by Ten Teachers, “Amenorrhea” (18th edition).