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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Parents and children often struggle with anxiety often known as Worriation. While everyone suffers from anxiety, not everyone suffers from an anxiety disorder. It starts affecting their normal life and routine, keeping them up at night. Many times, parents feel like they are losing it.

Dr. Lulu, a US Based pediatrician, author and coach has been helping parents and kids struggling with anxiety and self doubt, avoid self harm by learning to control their emotions and thoughts.

What is anxiety?

It is the mind and body’s reaction to stressful, dangerous or unfamiliar situations. It’s the sense of distress or dread you feel before a significant event. A certain level of anxiety helps us stay alert and aware, but for those suffering from an anxiety disorder, it feels completely debilitating.

While stress causes adrenaline release, it also causes cortisol release. While most people deal with stress in their life, for some it interferes with their daily functioning.

How to determine if it is a disorder?

Excessive worrying about things, prolonged worrying lasting for over 6 weeks, having trouble controlling worrying manifest as anxiety disorder symptoms.

If it becomes hard to control worrying, or if physical symptoms like restlessness, fatigue, irritability, concentration problems, muscle tension, and sleeping troubles persist and start affecting your everyday work and social life, it may be a disorder.

The lymbic system in our brain controls our thoughts, emotions, memory and motivation reinforcement. Overactivity or disregulation of the lymbic system due to excess adrenaline and cortisol release causes anxiety disorders.

Examples of anxiety disorders are:

· Specific Phobia

· Social Anxiety Disorder

· Post Traumatic Stress Disorder (PTSD)

· Obsessive Compulsive Disorder (OCD)

· Separation Anxiety Disorder

· Panic Disorder

· Mutism

Symptoms in children

Excessive worrying about future events, separation from safe places such as a parent or their home, feelings of panic in certain situations (sweaty palms, heart racing and heavy breathing) are some of the symptoms of anxiety noticed in children.

A common checklist:

· Sleep disturbances and difficulty

· Difficulty concentrating, inattention, poor focus

· Agitation and restlessness

· Avoidance of certain places / people

· Tantrums, crying, meltdowns

· Neglect of personal hygiene

· Decline in performance at school

· Withdrawal from activities or relationships

· Weight loss or gain

· High expectations at school, sports, homework, performances

· Fear of recent COVID 19 pandemic

How to control and manage it?

Dr. Lulu suggests a 3 step technique of Acknowledge, Analyse and Act.

· Talk: to self, to other, to a therapist or a doctor

· Guided meditation sessions (available online and on apps)

· Breathe: practice the 4-7-8 breathing technique or focused breathing

· Aromatherapy

· Take a 15 minute walk

· Practise Yoga

· Listen to some relaxing music

Anxiety disorders are the most common mental health disorders and are more common in children. But the good news is that they can be successfully treated by the right therapy and medication in severe cases.

Dr. Lulu can be reached at askdoctorlulu@gmail.com