Amenorrhea

Definition

Amenorrhea is the name given to the condition when a woman fails to have menstrual periods. The condition is known as "primary amenorrhea" when the woman has never menstruated; and "secondary amenorrhea" if her periods cease after having been regular for months or years.

Description

If you are reaching the age of 16 years without ever having menstruated, the chances are that you are developing normally, but a little later than most girls. If you are very athletic or quite thin, menarche could be delayed.

However, because there is a small possibility that you have a hormonal abnormality, consult a physician, especially if other sexual changes also have been delayed - if your breasts and pubic hair have not yet begun to grow, for example.

If you have been menstruating for years and suddenly miss one or several periods, you have secondary amenorrhea. There are several possible explanations for this.

You might be pregnant, perhaps you lost a lot of weight rather quickly or have been exercising a lot, or you may have been under stress. Very obese women sometimes fail to menstruate. You also could be taking a medication that suppresses menses as a side effect.

If you just quit taking oral contraceptives, you may not have a period for several months. In addition, breastfeeding can delay menstruation, and if you are reaching the age of menopause, it would be normal to begin skipping periods.

Secondary amenorrhea due to the above causes is quite common. More serious problems, such as tumors or disorders of the pituitary gland, also can cause amenorrhea, but they are rare.

Failure to resume menstruation after childbirth, particularly if lactation does not take place, may mean that the pituitary gland failed either partly or completely at the time of delivery, a condition called postpartum pituitary necrosis.

If you have been menstruating regularly and your period is more than two weeks late, you may want to see a physician to find out if you are pregnant. However, if you are sure that you are not pregnant and you have no other symptoms, there is no harm in waiting for six to nine months before consulting a physician. Keep in mind that even if you are not menstruating, you could still become pregnant if you do not take precautions.

Causes and Risk Factors

The most common cause of amenorrhea is pregnancy, and this is always excluded before other possible causes are considered.

Female ballet dancers, female joggers and women involved in vigorous sports frequently find they skip menstrual periods or stop menstruating altogether. This is more likely to happen if you are young, especially if your cycle is generally irregular. In fact, teenagers who train heavily are often late in their teens before they actually have their first menstrual period.

Medical experts believe that several factors are involved, including stress, and perhaps the ratio (proportion) of fat cells in your body to other cells. Going on a crash diet and losing a large amount of weight very rapidly also can interfere with menstruation. In both cases, you stop menstruating because your ovaries do not produce enough estrogen in the cyclic manner that causes the uterus lining to thicken and then shed.

If you reduce your exercise schedule or gain weight, you probably will begin to menstruate again. If that does not work, or if you do not want to exercise less or gain weight, your physician may suggest that you take estrogen in low doses.

Treatment

Your physician may prescribe various types of hormones to see whether your ovaries are functioning normally.

Provided no underlying disorder is causing the amenorrhea, treatment is generally unnecessary. However, because women who are not menstruating seem susceptible to osteoporosis, your physician may suggest that you take estrogen and a calcium supplement.

If an underlying disorder is to blame for either primary or secondary amenorrhea, the treatment will depend on the nature of the disorder.

Questions to Ask Your Doctor

Do any tests need to be done for diagnosis and to determine the cause?

What is the cause?

What treatment do you recommend?

Will you be prescribing any medication? What are the side effects?

What's likely to happen if no treatment is undertaken?