Amenorrhea: Causes, Symptoms, Risk Factors, Diagnosis, Treatment And Complications

Amenorrhea, the lack of menstruation, is usually considered to signify that one or more menstrual cycles have been missed.

Primary amenorrhea is defined as not having gotten a period by the age of 15. Primary amenorrhea is most often caused by hormone levels, though anatomical problems can also induce amenorrhea.

Secondary amenorrhea is the term used to describe the stop of menstruation for a person who had previously experienced periods for three months or longer. Pregnancy is the most prevalent cause of secondary amenorrhea, while hormone problems can also occasionally be the reason.

The treatment of amenorrhea depends on its underlying cause.

Causes Of Amenorrhea

Amenorrhea can have multiple causes. While some can be ordinary, others might be symptoms of a medical problem or a medication adverse effect.

Natural menstruation

The following are the possible natural causes of amenorrhea during your lifetime:

• Having a pregnancy
• A baby's birth
• The menopause 

Certain individuals who use birth control pills or oral contraceptives are unable to get 

their period. Even after using birth control, it could take some time until regular menstruation and ovulation return. Other contraceptives that can cause amenorrhea include injectable and implanted forms, as well as several IUDs.

Medications

Taken in conjunction with specific medications, such as certain types of:

• Antidepressants
• Chemotherapy for cancer
• Psychotropic drugs
• Medications for blood pressure
• Anti-allergy drugs
• Lifestyle modifications

Occasionally, the following lifestyle variables may result in amenorrhea:

• Low body mass: Approximately 10% under normal weight, or an extremely low body weight, throws off the body's hormonal balance and can even interrupt ovulation. Women who suffer from eating disorders, such as bulimia or anorexia, often stop menstruation as a result of these abnormal hormonal swings.
• Exercising too much: Ballet dancers and other physically demanding women may have irregular menstrual periods. Stress, low body fat, and high energy expenditure are a few factors that can combine to produce menstruation loss in athletes.
• Stress: When you are under emotional stress, the hypothalamus, a part of the brain that controls the hormones that govern your menstrual cycle, may suddenly malfunction. This could lead to the cessation of ovulation and menstruation. As your stress level decreases, regular menstrual cycles usually resume.

Hormonal imbalance

Several medical disorders, including the following, may be brought on by hormonal imbalance:

• Polycystic Ovary Syndrome, or PCOS: Quite than changing like in a normal menstrual cycle, hormone levels in PCOS are quite high and consistent.
• A thyroid disorder: Both an overactive thyroid gland (hyperthyroidism) and an underactive thyroid gland (hypothyroidism) can induce irregular menstruation, including amenorrhea.
• The tumour of the pituitary: You may be experiencing hormone disruption related to your menstrual cycle from a benign (noncancerous) tumour in your pituitary gland.
• Preterm menopause: Age 50 is usually when menopause begins. Still, some women cease to menstruate and have a decrease in their ovarian reserve before turning 40.

Anatomical problems

Concerns about the actual sexual organs themselves can sometimes lead to amenorrhea. As an example, consider:

• Uterine lacerations: Scar tissue buildup in the uterine lining is a condition known as Asherman's syndrome. It may sometimes arise after dilatation and curettage (D&C), after caesarean delivery, or after treatment for uterine fibroids. Urinary scarring prevents the normal build-up and clearance of the uterine lining.
• Absence of reproductive organs: Sometimes problems with foetal development lead to the complete absence of reproductive system organs such as the uterus, cervix, or vagina. Menstrual periods are not possible later in life since the reproductive system has not fully developed.
• Structural abnormality in the vagina: A vaginal obstruction may stop noticeable menstrual bleeding. A wall or membrane that stops blood from exiting the uterus and cervix may exist in the vagina.

Also Read: Vaginal Yeast Infections: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Symptoms Of Amennorhea

Depending on the cause of amenorrhea, an absence of periods may be followed by other signs or symptoms, such as:

• Nipple discharge
• Thinning hair
• Headache
• Changes to vision
• Excessive facial hair
• Pain in the Pelvis
• Acne

Also Read: Genital Warts: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Risk factors Of Amenorrhea

Your risk of amenorrhea may be increased by the following factors:

• History within the family: If previous women in your family have experienced amenorrhea, you may have inherited the disorder.
• Eating disorders: If you have an eating disorder like bulimia or anorexia, your chances of experiencing amenorrhea are increased.
• Excessive Exercise: Your risk of amenorrhea may increase with intense physical training.
• Past experiences with particular gynaecological procedures: You are more likely to have amenorrhea if you have had a D&C or loop electrodiathermy excision procedure (LEEP), especially if it was connected to pregnancy.

Also Read: Placenta Accreta: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Diagnosis Of Amenorrhea

During the visit, your doctor will examine your pelvis to check for any reproductive system concerns. If you have never had a period, your doctor may examine your genitalia and breasts to see whether you are undergoing the normal changes associated with puberty.

Several complex hormonal problems can be indicated by amenorrhea. Finding the root of the issue could need some time and several different kinds of testing.

Tests: A variety of blood tests, like the ones listed below, can be necessary:

• Take a pregnancy test: This is probably the first test that your doctor would offer to rule out or confirm a possible pregnancy.
• Thyroid function test: By testing for thyroid-stimulating hormone (TSH) in your blood, you can determine how well your thyroid is f
• An examination of the ovary: Follicle-stimulating hormone (FSH) can be measured in blood samples to determine whether your ovaries are operating correctly.
• Prolactin test: A malignancy in the pituitary gland may be indicated by prolactin levels that are below normal.
• Test of the hormones in men: Your doctor may want to check your blood for male hormones if you have more facial hair and a lower voice.

Hormone Challenge Test

To cause menstrual bleeding, you take a hormonal medication seven to ten days before the test. Your doctor can assess whether an oestrogen deficit is the cause of your cessation of periods based on the test results.

Radiological tests

Based on your symptoms and signs, the results of any blood tests you've done, and other factors, your doctor may recommend one or more imaging tests, such the ones listed below.

• Ultrasonic: This test uses sound waves to create images of internal organs. If you've never been on your period, your doctor can suggest an ultrasound to check for reproductive organ issues.
• Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) creates extremely detailed images of the body's soft tissues by using radio waves and a strong magnetic field. 

Scope tests

If additional tests fail to reveal the problem, your doctor may recommend a hysteroscopy. Through your cervix and vagina, a thin, lighted camera is inserted to observe the interior of your uterus during this procedure.

Also Read: Uterus Didelphys(Double Uterus): Causes, Symptoms, Diagnosis, Treatment and Complications

Treatment Of Amenorrhea

How your amenorrhea is treated will depend on its underlying cause. Menstrual cycle restarting is a possible side effect of birth control pills and other hormone therapies. When amenorrhea results from thyroid or pituitary disorders, medication may be used to treat it. A tumour or anatomical blockage may be the cause of the problem, so in that case, surgery might be necessary.

Also Read: Bacterial Vaginosis: Causes, Symptoms, Risk Factors, Complications, Prevention, Diagnosis And Treatment

Complications Of Amenorrhea

The reasons for amenorrhea may also give birth to other problems. These comprise:

• Pregnancy-related problems and infertility: If you are not ovulating or having your period, you cannot become pregnant. Miscarriage or other pregnancy-related problems may also occur when amenorrhea is caused by an imbalance in hormones.
• Psychological stress: Not getting your period when your friends do might be stressful, particularly if you're a young adult starting out in adulthood.
• Osteoporosis and vascular illness: These two problems might be brought on by insufficient oestrogen. Osteoporosis is the term for the weakening of bones. Cardiovascular disease include heart attacks as well as problems with the heart muscle and blood vessels.
• Pain in the pelvis: If the amenorrhea stems from an anatomical problem, discomfort in the pelvic area.

Also Read: Urinary Tract Infection: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

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