Amenorrhea: Causes, Diagnoses & Treatment
Remember
·
Amenorrhea means absent or no periods.
·
Stress, weight problems, excess exercise, PCOS, and pregnancy
commonly cause amenorrhea.
·
Girls should have their first period by age 15 (or 2-3 years
after starting breast development).
Amenorrhea, pronounced “a-men-or-re ah” means absent or no menstrual periods. If you
haven't had your period yet or you've missed a few, you're probably wondering
what's going on with your body.
What
is amenorrhea?
Amenorrhea is considered a “menstrual condition”. There are two types of amenorrhea: primary and secondary.
Primary amenorrhea is the
term used when a young woman has never had a period. Most girls get their periods between 9 and 15 years old, or about 2-3 years
after they start their breast development.
Secondary amenorrhea is a
term used when a young woman has had a period before, but stops having them.
For example: Your periods were regular for the first two years and now they
don't come at all. Or you only have 2 or 3 periods a year and sometimes 6
months goes by without a period.
What
causes amenorrhea?
There
are many possible causes of amenorrhea, including the following:
·
Pregnancy - If
a female is sexually active and she doesn't use contraception, or her method of
contraception has failed, amenorrhea can mean that she is pregnant.
·
Changes in weight and
disordered eating - Many girls will develop amenorrhea if
they gain or lose 5 pounds, are too thin (low BMI), have anorexia nervosa or
bulimia or other disordered eating such as using vomiting or
excessive dieting to control weight.
·
Exercise -
Girls who participate in sports such as running or gymnastics or in activities
such as ballet often have athletic amenorrhea. This can be due to low
weight, weight loss, or stress. Even an athlete who weighs a normal amount may
not be taking in enough nutrition to keep her body healthy and may skip
periods.
·
Polycystic Ovary Syndrome
(PCOS) - Girls with PCOS
typically have irregular menstrual cycles and excess hair growth or acne, and
are often overweight. Girls with PCOS may experience fewer than 9 menstrual
cycles a year, or skip 3 or more months at a time.
·
Obesity -
Being excessively overweight makes a girl more likely to have irregular
menstrual periods.
·
Endocrine problems -
Low or high thyroid hormone, too little or too much adrenal hormones such as
cortisol, and too much prolactin which is secreted by the pituitary gland in
the brain that can cause irregular periods or amenorrhea. High prolactin levels
can also be caused by medications such as resperidol.
·
Chronic illness -
Girls with many diseases such as Crohn's disease, celiac disease, cystic
fibrosis, sickle disease, lupus, diabetes,
and others may have irregular menstrual periods or amenorrhea because of low
weight or a flare in their illness.
·
Medications and herbs -
Some medications can cause amenorrhea. Be sure to tell your health care
provider about ALL the medications and/or over-the-counter supplements and
herbs that you take.
·
Ovary problems -
Sometimes the ovaries do not make enough estrogen to cause periods because of a
genetic problem such as Turner syndrome or galactosemia, previous radiation or
chemotherapy to treat a tumor, lack of enough follicles in the ovary for the
teen and adult years, and many other reasons. The condition is called primary ovarian insufficiency and is treated
with hormones to replace the estrogen that the ovaries normally make.
·
Congenital anomalies of the
reproductive tract - A birth defect such as an underdeveloped
or absent uterus (the organ where menstrual blood comes from) can
cause lack of periods. Although rare, if a teen girl is 15 or older or started
her breast development 3 years ago and doesn't have her period yet, a
congenital anomaly may be considered and an ultrasound
may be ordered by her health care provider to see if the uterus has developed.
How
is amenorrhea diagnosed?
Not having a period for more
than a couple of months isn't normal, and finding out why is important.
Diagnosis starts with having a pregnancy test and a medical evaluation by a
health care provider (HCP).
The exam begins with reviewing your medical history.
For
example, your HCP will likely ask the following questions:
·
When did you start to go through puberty and develop breasts?
·
Have you ever had any vaginal bleeding?
·
When was your last menstrual period?
·
Has your weight changed?
·
Are you under stress or depressed?
·
Do you have an eating disorder or vomit to try to control your
weight?
·
How much do you exercise?
·
Do you have excessive hair growth or gain weight easily?
·
Have you ever had sexual intercourse?
·
Do you use contraception?
·
Do you take any medicine? If so, what?
The other part of the
evaluation is a physical
exam. Your HCP will listen to your heart and lungs, check your
thyroid gland (in your neck), and check your body for any skin changes or
excess hair. It's important to tell your HCP if you remove any unwanted hair,
particularly on your face (upper lip/sideburns/chin) or on your chest or back.
Your HCP will tell you if a pelvic exam
is important to make sure that everything is okay with your hymen, labia,
vagina, cervix and uterus. Instead of a complete pelvic exam, your HCP may do
certain parts of the pelvic exam such as checking to make sure your hymen is
open and using a small Q-tip in your vagina to make sure the length is normal.
Your HCP may also have you get an ultrasound.
Your HCP may then obtain blood tests to look
at hormone levels or refer you to a specialist in adolescent medicine or
gynecology who sees girls with irregular periods.
Does
it matter if you skip periods?
Many girls will skip an
occasional period if they are ill, stressed, have just started their periods,
or are away at camp in August, but regular periods are sign that you are
healthy and making enough estrogen to keep your bones strong. So if you are
skipping periods, it's important to find out why and whether you need treatment.
Make sure that you take in 1200-1500 mg of calcium and vitamin
D (600 units/day).
What
is the treatment for amenorrhea?
Treatment depends upon
the cause of the amenorrhea and may include:
·
Changing your exercise pattern
·
Talking with a nutritionist and eating a healthy diet
·
Seeing a counselor about stress or disordered eating
·
Hormones such as progesterone, estrogen, or birth control pills
What's important is that you
listen to the options and decide what type of treatment is best for you.
Most conditions that cause amenorrhea can be treated
with medication and lifestyle changes. Make sure you're getting enough calcium
and vitamin D.
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