Here is All You Need to Know About Absent Menstruation(Amenorrhea)

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Absent menstruation or Amenorrhea as it is called in medical terms, is the absence of menstrual bleeding or menstrual periods. Amenorrhea is a condition in which women having regular periods, miss at least three menstrual periods in a row or when girls do not have their first menstrual period by the age of 15.

Many women suffering from amenorrhea deal with a lot of anxiety and stress, even leading to depression in some cases

Types of Amenorrhea

There are two types of amenorrhea – primary and secondary.

Primary amenorrhea
Primary amenorrhea is when periods do not start during puberty. Most girls begin menstruating between ages 9 and 18, with 12 being the average age. If girls do not get periods by the age of 15, then it is considered a case of primary amenorrhea, which may need medical attention.

Secondary amenorrhea
Secondary amenorrhea is when periods have started, but then they cease to occur. Pregnancy and breastfeeding are the most common reasons for this, however, there can be several other reasons for this, that need medical assessment.

Causes

Amenorrhea can occur for a variety of reasons. During the normal course of your life, women may experience amenorrhea for natural reasons, such as –

Pregnancy
Breast-feeding
Menopause

Pregnancy tests, either urine or blood tests, can be done to confirm pregnancy which is considered as the most common reason for absent periods.

Other causes of Amenorrhea include –
Contraceptives – Some women who take birth control pills may not have periods. Even after stopping contraceptives, it may take some time before regular ovulation and menstruation return.

Lifestyle factors – Many a times lifestyle factors contribute to amenorrhea:

Excessive exercise – Women who undergo rigorous physical activity or exercise are highly likely to have interrupted menstrual cycles.
Stress – Mental stress can temporarily alter the functioning of the hypothalamus — an area of your brain that controls the hormones that regulate your menstrual cycle, causing temporary stopping of periods.
Low body weight – Excessively low body weight interrupts many hormonal functions in your body, potentially halting ovulation and causing missed/absent periods.

Hormonal imbalance – Hormonal imbalance can happen due to a number of underlying conditions like:

Polycystic ovary syndrome (PCOS) – PCOS causes relatively high and sustained levels of hormones, rather than the fluctuating levels seen in the normal menstrual cycle.
Thyroid malfunction – An overactive thyroid gland (hyperthyroidism) or underactive thyroid gland (hypothyroidism) can cause menstrual irregularities, including amenorrhea.
Pituitary tumour – A non-cancerous tumour in your pituitary gland can interfere with the hormonal regulation of menstruation.
Premature menopause – Menopause usually begins around age 50. But, for some women, the ovarian supply of eggs diminishes before age 40, and menstruation stops.

Medications – Certain medications, such as antipsychotics, cancer chemotherapy, antidepressants, blood pressure and allergy medications can cause menstrual periods to stop

Structural problems – Problems with sexual organs such as lack of or under-developed or abnormal uterus or vagina can cause amenorrhea

When to see a doctor?

Primary amenorrhea
When a teenage girl hasn’t gotten her first menstrual period by the age of 15, it is advised to see the doctor.

Teenage girls usually show signs of puberty in the following order –

Thelarche (breast bud development)
Pubarche (pubic hair development)
Menarche (onset of menstrual periods)

If a teenage girl is fourteen or older and hasn’t experienced any signs of puberty yet, it is advised to seek medical help.

Secondary amenorrhea
It is advisable for menstruating women and teens to see a doctor if the individual

used to have regular periods and then does not have any for 3 months
used to have irregular periods and then does not have any for 6 months

Do I really need to consult a Doctor?

It is quite likely that you may not experience any discomfort even if you have amenorrhea. But it is still advisable to see the doctor. This is because amenorrhea might be due to an underlying condition that may require review and treatment.

Some other complications due to amenorrhea include –

Infertility – If you don’t ovulate and have menstrual periods, you can't become pregnant.
Osteoporosis – If your amenorrhea is caused by low estrogen levels, you may also be at risk of osteoporosis — a weakening of your bones.
Heart disease – It is suspected that low oestrogen levels also put a woman at risk of heart disease. Also, women having amenorrhea associated with PCOS are more likely to develop risk factors for heart disease, such as high blood pressure, high cholesterol levels, and diabetes.

Treatment

Treatment for amenorrhea varies depending on the underlying cause.
Hormonal imbalances can be treated with supplemental or synthetic hormones, which can help normalize hormone levels

If lifestyle factors are found to be the cause of amenorrhea, the doctor may suggest lifestyle changes.

In the case of weight issues, the doctor may recommend healthier diet options. A consultation with a dietician or nutritionist may be suggested.

In the case of stress-related amenorrhea, the doctor may suggest ways to manage stress, such as yoga, mindfulness, and meditation. A consultation with a therapist may be suggested. A change in exercise routine may also be suggested.

In case the doctor’s review reveals that ovarian cysts, scar tissue, or uterine lesions are causing amenorrhea, the doctor may choose to remove these using medications or surgery. Surgery may also be recommended for structural problems with the reproductive organs

Not a disease

Amenorrhea (absent menstruation) is not a disease per say. It is a condition that can be a sign of an underlying health issue that needs attention. In contrast to popular belief, amenorrhea does not indicate that a person is infertile. In most women, amenorrhea is treatable. Treatment of amenorrhea usually involves treating the condition that is causing amenorrhea. Consulting a doctor with your concerns is the key. Following the treatment plan recommended by the doctor can help most people with amenorrhea get their menstrual cycle regular and back on track.

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A late, irregular, or missed period can indicate anything from simple stress to a serious medical condition. Most women usually get their periods every 28 days. However, any menstruation cycle ranging from 21 to 35 days is also considered normal. Sometimes, a slight change in the cycle can occur due to change in workout regime, illness, stress, or minor hormonal imbalance. Moreover, if one is experiencing either onset of the menstrual cycle or menopause, irregular periods become almost inevitable given the changes that the body goes through during these times.

Some of the reasons for late and irregular periods are listed below.

1. Obesity or low body weight

Women who are underweight usually suffer from disordered functioning of the body. For an underwent weight body, it is difficult to keep up with overall process ovulation. Late or missed periods can also be associated with health disorders like anorexia in skinny girls. Therefore, in such conditions, health experts advise women to gain appropriate kilos to regulate the overall functioning of the body. On the flip side imbalance in hormones can also lead to irregular periods in overweight women. More often, obesity in women can point towards other health complications like polycystic ovary syndrome (PCOS) that directly affects period cycles. Therefore, in every case maintaining a healthy Body Mass Index (BMI) is suggested.

2. Stress

While uninstalling social media apps like WhatsApp and Instagram may help one to be at peace for some time, stress may lead to a more serious mental health issue by directly affecting hypothalamus- a part of the brain that is responsible for regulating the periods. Moreover, stress can impact both weight loss and weight gain that leads to an imbalance in the menstruation cycle. If you haven’t been taking care of yourself lately add up some meditation and exercise in your schedule.

3. PCOS

During PCOS (polycystic ovary syndrome) your body starts producing more male hormones or testosterone. As a result of hormonal imbalance, ovaries develop a layer of a cyst and make ovulation irregular.

4. If you are on birth control pills

If you keep going on and off on birth control pills, you may experience a change in your menstruation cycle. Birth control pills are rich in hormones like progestin and estrogen that helps in preventing your ovaries from releasing an egg. Moreover, other kinds of birth control that are either injected or implanted can also cause missed periods.

5. Early menopause

Unlike other women who experience menopause at the age between 45-55, some experience it around their early 40s’. If the periods are being irregular or missed altogether and you are around 40s’ you might be just experiencing early menopause. However, getting a period after a year of menopause calls for an immediate medical checkup.

6. Thyroid issues and chronic diseases

Long-lasting diseases like celiac disease and diabetes can also impact your menstrual cycle and can easily be cured with medical assistance. Moreover, an underactive or overactive thyroid gland could also be responsible for missed or late periods. These issues can be treated with proper medication and periods are likely to return back to normal.

7. When to schedule a doctor’s visit?

In most of the cases, irregular or missed periods are normal and are not to be worried much about but one must seek a doctor’s visit in all cases of unusually heavy bleeding, nausea, bleeding that lasts longer than seven days, high fever, or extreme pain.