By Laura Gil Aliaga BSc, MSc (embryologist).
Last Update: 10/28/2015

Ovulation comes with a range of symptoms produced by our organism through hormonal connections between the brain and the ovaries, called hypothalamo-pituitary-ovarian (HPO) axis. When these signals do not work, an absence of period occurs, and this is what we call functional amenorrhea. Clearly, this kind of disease may only appear among women who have had the period previously, in other words, women who have regular menstrual cycles and are in reproductive age.

The different sections of this article have been assembled into the following table of contents.

Causes

Generally, there are several possible causes, and the most frequent usually is an excessive loss of weight in a short amount of time, due to eating disorders or to eating plans that are not being guided by a dietitian, and can damage our organism. If we come into having a Body Mass Index (BMI) lower than 19, this disease is likely to happen.

In the same way, stress—either job or study stress—is another possible factor causing amenorrhea. Psychiatric diseases such as anxiety or depression can develop into amenorrhea as well.

Intense physical exercise can be another reason leading to a missing period, mostly referring to girls that practice sport professionally and very intensively.

On the other hand, if there was any unregulated hormone inside the body, like prolactin, when their levels are above normal (hyperprolactinaemia), amenorrhea may occur.

Symptoms

Possible symptoms, apart from a missing period due to a lack of ovarian oestrogens, are:

  • Altered mental status
  • Sleep disturbances
  • Decreased libido, altough it may be due to vaginal dryness, which can lead to painful intercourse (dyspareunia) as well

As a consequence of amenorrhea, secondary infertility may occur due to anovulation.

In women desiring to get pregnant, the fustration, anxiety, stress, etc. that this situation causes, make it possible that amenorrhea may last over time, which leads to severe anxiety, becoming thus trapped in a vicious circle that requires psychological attention to get it over with.

Diagnosis

In order to diagnose this illness it is necessary that there was no period during at least three months. In that moment, once you have visited the specialist, he or she should rule out pregnancy, however unlikely it might be.

General routine is getting the patient’s medical history, in order to bring backgrounds to the gynaecologist and being able to value if there is any disorder causing it. This will be followed by a physical exploration to value the genital tract as well as to verify, for example, the Body Mass Index (BMI).

A vaginal/abdominal ultrasound is usually carried out, which will complete the physical exploration, helping thus to value the estrogen deficit. The latter will be more exactly determined by an hormonal analysis.

Treatment

There’s no need to get excessively worried as this disease has a solution. Such solution must be sought in order to avoid negative effects in the future, always looking for the origin and focusing on its correction, for instance, by returning to a healthy and balenced life, improving eating habits, and reducing the practice of physical exercise.

Usually, fixing bad habits cannot be done in the blink of an eye. On the contrary, it will be necessary to go step by step and gradually. To meet such purpose, the gynaecologist may suggest an additional medication as a compensation for the estrogen deficiency.

The solution for this disease comes when ovulation is back again in a normal way. From that moment onwards, the patient’s life will be as usual also regarding pregnancy chances as the woman’s hormone levels have been restored and she will have recuperated her fertility.

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Authors and contributors

 Laura Gil Aliaga
BSc, MSc
Embryologist
Bachelor's Degree in Biology & Biochemistry from the Miguel Hernández University of Elche (UMH) and the University of Alicante (UA). Master's Degree in Biology of Human Assisted Reproduction. Embryologist at clinic UR Vistahermosa (Alicante, Spain). More information
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