Amenorrhea Or Absence Of Menstruation: Causes & Treatment

By BSc, MSc (embryologist), (embryologist), (gynecologist) and (invitra staff).
Last Update: 09/01/2020

Menstruation is caused by a series of signals produced by our body through hormonal connections between the brain and the ovaries, which we call the hypothalamus-pituitary-ovarian axis.

On many occasions, women of childbearing age visit their OB/GYN when their monthly bleeding unexpectedly stops. This phenomenon is known as amenorrhea and can have different causes.

What is amenorrhea?

Amenorrhea is the absence of menstrual period. This disorder may be due to an occasional, intermittent problem or permanent factors in the woman.

As soon as a woman hits puberty, her monthly bleeding begins and happens once a month until age 45-50. At about this age, menopause begins and menstrual bleeding stops. However, this physiological interruption of menstruation with the start of the menopausal stage does not count as amenorrhea.

Consequently, the absence of menstruation can be classified as:

Primary amenorrhea:
absence of menstruation in a 15-16-year-old girl with normal growth and development This type of amenorrhea has an incidence of 0.1% and is manifested by delayed menarche, the first period bleeding.
Secundary amenorrhea:
the woman has menstruated throughout her life up to a certain point. Specifically, the patient must have had 3 cycles or 6 months without a period to be diagnosed with amenorrhea. Its incidence is 0.7% and is normally due to the lack of hormone production.

On the other hand, in those women who wish to become pregnant, the frustration, anxiety, and stress caused when pregnancy does not occur, can cause amenorrhea. Moreover, if the absence of menstruation continues for a longer period of time, pregnancy will not occur and this, in turn, increases the degree of anxiety, thus creating a negative vicious circle.

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Causes

There are multiple causes why a woman does not menstruate and can be related to disorders in the brain, ovaries, uterus, and vagina or even genetic factors.

In the case of primary amenorrhea, genetic disorders such as Turner's syndrome, Kallmann's syndrome, or congenital adrenal hyperplasia can result in the absence of menstruation in women. In addition, congenital defects of the female reproductive organs are also a cause of this type of amenorrhea, since they block the menstrual blood from leaving the body.

On the other hand, secondary amenorrhea may be due to:

Although these are the most frequent causes of amenorrhea, if there were any hormonal imbalance in the body, the absence of menstruation could also occur. For example, when prolactin levels are above normal (hyperprolactinemia), it could be the case that menstrual bleeding stops. This is the reason why during lactation (high prolactin level) many women do not have their period.

Risk Factors

There are factors that increase a woman's chance of suffering from amenorrhea. Some of them are described below:

  • Family history of other women who present amenorrhea.
  • Eating disorders, such as anorexia or bulimia. This pathology also occurs in women with a Body Mass Index below 19.
  • High performance sport activity.

It should be noted that stress is another factor that causes a woman to stop bleeding, including not only situations at work or school, but also those of a psychiatric illness that can generate a lot of stress such as anxiety or depression.

Symptoms of amenorrhea

The absence of menstruation is the main symptom of amenorrhea in a woman. In addition, the lack of estrogen release by the ovary can lead to the appearance of the following clinical manifestations:

  • Emotional imbalance.
  • Sleep disturbance.
  • Decreased libido.
  • Vaginal dryness and which in turn results in painful intercourse.
  • Hair loss.
  • Headache.

It is important to know that the hormonal imbalance in the case of amenorrhea causes anovulation and, therefore, the appearance of secondary sterility.

Diagnosis

In order to diagnose this illness, it is necessary that there was no period during at least three months. From this moment on, she should rule out pregnancy, however unlikely this might be, by visiting her OB/GYN.

Once pregnancy has been excluded, the general protocol is to take the patient's medical history to provide the gynecologist with a patient's history and to be able to assess whether there is any disorder that may induce it. This will be followed by a physical exploration that serves both to assess the gential tract as well as to evaluate the Body Mass Index (BMI).

The doctor will also perform a vaginal/abdominal ultrasound that will complement the physical examination and a hormonal analysis to assess the estrogen deficit. In addition to estrogen levels, other hormones such as FSH, LH, prolactin, etc. will be examined.

As complementary techniques for the diagnosis of amenorrhea, a head CT scan, endometrial biopsy, genetic testing or an MRI may be requested.

Treatment for amenorrhea

There is no need to worry excessively about this since this pathology has a solution and it is convenient to solve it in order to avoid negative effects in the future.

Therefore, it is of vital importance to value the origin of amenorrhea and seek solutions based on it, such as returning to a healthy and balanced life, improving eating habits, and moderating physical exercise.

It often results complicated to change negative habits overnight, which is why it is important to proceed little by little. For this purpose, gynecologists often prescribe additional medication in order to correct low estrogen levels.

Once the patient has her menstruation on a regular basis again, this pathology is considered to have been cured. From this moment on, the woman can return to her normal lifestyle and even get pregnant since her hormone levels have been restored again thus having regained her fertility.

Amenorrhea due to hormonal contraceptives

Hormonal contraceptive methods cause a blockage of ovulation by acting on the regulation system of the menstrual cycle, the hypothalamus-pituitary-ovarian axis. Thus, the hormones naturally released by the ovary are administered by the contraceptive (given orally, by injection or implant). Most hormonal contraceptives contain high amounts of estrogen and progesterone.

This leads to the brain (hypothalamus and pituitary) reducing or blocking the release of FSH and LH hormones and therefore prevents ovulation. This special hormonal situation leads to very light, short periods with little bleeding and even in some cases total amenorrhea.

When stopping hormonal administration, the body may need some time to re-establish the hormonal imbalance and this may lead to common temporary amenorrhea of between 1 and 4 months after stopping the contraceptive methods. However, should amenorrhea continue, it is advisable to visit the OB/GYN who will induce the first menstruation and regulate the patient’s hormone profile.

FAQs from users

Is natural pregnancy with amenorrhea possible?

By Dra. Paula Fabra Roca (gynecologist).

In principle the answer is no. Amenorrhea (absence of menstruation for 6 months) is the result of a lack of ovulation, a process by which the egg is just prepared biologically to be fertilized and is released from the ovary through a process of follicular rupture.

If the egg does not undergo the process of ovulation, it will not leave the ovary and therefore cannot be fertilized, since the fertilization of the egg by the sperm occurs at the level of the Fallopian tube.

The release of the egg from the ovary produces cellular changes at this level that will cause a series of hormones to be secreted, which will lead, 14 days later, to menstruation. Therefore, if there is no ovulation, there will be no pregnancy and no menstruation.

Even so, we must be very careful with this statement, because when amenorrhea is secondary to a reversible noxa, this state of anovulation can be resolved at any time. In these cases, the woman will not be aware that she has ovulated until 14 days later when her menstruation startes. So a patient with amenorrhea who does not want to become pregnant should take the necessary precautions to avoid it since we do not know when this state can be reversed.

What is the prognosis for amenorrhea?

By Marta Barranquero Gómez (embryologist).

The prognosis of amenorrhea will depend on the type and cause of the absence of menstruation. In the case that the amenorrhea is due to a cause and has a cure, the prognosis is favorable.

However, if the absence of menstruation is caused by cancer or any other serious condition, the prognosis will be complicated.

Is amenorrhea genetic?

By Marta Barranquero Gómez (embryologist).

Primary amenorrhea, that is, the absence of menstruation in women when they reach puberty, is often related to genetic disorders that cause malformations of the female sex organs.

An additional risk factor is a family history of amenorrhea, so it is important to visit the OB/GYN on a regular basis.

Why does breastfeeding cause amenorrhea?

By Marta Barranquero Gómez (embryologist).

The main reason for the absence of menstruation during lactation is related to suction and blocking of ovarian function.

When the baby suckles, the function of the hypothalamus-pituitary axis is inhibited and therefore no hormones are produced that control ovulation. In this way, the maturation of the egg in the ovary does not take place, nor is progesterone generated. The result of these effects is the absence of menstruation in the woman.

In addition, the levels of the hormone prolactin in lactation are high, which also leads to a maladjustment in the hypothalamus-pituitary axis and causes amenorrhea.

Suggested for you

One of the causes of a missing period is the presence of high prolactin levels in the blood. If you want more information about this alteration, you can visit the following article: What is Hyperprolactinemia? Causes, Symptoms, and Treatment.

We have mentioned that amenorrhea can cause sterility in women. However, this is not the only reason a woman may have difficulty achieving a pregnancy. If you wish to continue reading about the subject, we recommend you to visit the following post: What is Sterility in Women? Symptoms and Treatment Options.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

 Laura Gil Aliaga
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 about Laura Gil Aliaga
 Marta Barranquero Gómez
Marta Barranquero Gómez
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
Dra. Paula Fabra Roca
Dra. Paula Fabra Roca
Gynecologist
Dr. Paula Fabra has a degree in Medicine and Surgery and specializes in Obstetrics and Gynecology. She also has a Master's degree in Assisted Human Reproduction. More information about Dra. Paula Fabra Roca
collegiate number: 51123
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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