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.