Amenorrhea - Absence of Menstruation

Amenorrhea is the absence of three or more consecutive menstrual periods or delayed menstruation in girls over the age of 15 who have never had a menstrual period. Under normal circumstances, a woman has a regular menstrual cycle approximately 28 days in length (may vary from 21 to 35 days).

Causes

Pregnancy is the most common cause of amenorrhea and is completely natural without the need for treatment. In this case, amenorrhea is usually accompanied by other signs of pregnancy, such as fatigue, milky discharge from the nipples and headache. Similarly, breastfeeding women do not usually menstruate and amenorrhea in menopausal women is normal.

Abnormalities of the reproductive organs, endocrine glands and hormone production may also cause amenorrhea in some cases. For example, polycystic ovary syndrome is a condition that may cause amenorrhea or irregular menstrual periods and is also accompanied by symptoms, such as hirsutism (excessive hair growth) and oily skin or acne. Structural abnormalities of the uterus or other reproductive organs may also be involved as a causative factor.

Some medications can disrupt ovulation and menstruation leading to amenorrhea, including:

Contraceptive pills
Antipsychotic drugs
Antidepressant drugs
Chemotherapeutic drugs
Hypertension drugs

Other lifestyle factors that may contribute to causing amenorrhea include low body weight, excessive physical exertion and high stress levels. Each of these can interfere with the production and function of hormones, and lead to amenorrhea.

Epidemiology

In the United States, the incidence of primary amenorrhea is less than 1% and only approximately 1 in every 20 women of childbearing age have secondary amenorrhea.

Amenorrhea has been linked to an increased risk of other health conditions, such as osteoporosis, heart disease and infertility. As a result, amenorrhea can have an impact on the quality and quantity of life of affected women due to these secondary conditions.

Diagnosis

The diagnosis of amenorrhea may include:

Consultation about medical history and symptoms
Physical examination
Blood tests to monitor hormones and function of the ovaries, thyroid gland and pituitary gland
Imaging tests to check for structural abnormalities in reproductive system

If the cause is not able to be identified with these diagnostic tests, a hysteroscopy may be needed to investigate any structural abnormalities of the reproductive system.

Treatment

The best course of action for a woman with amenorrhea depends on the cause of the condition.

Hormonal medications, such as the oral contraceptive pill, are often effective in normalizing hormonal levels and inducing menstruation. Additionally, metformin, used in the treatment of type 2 diabetes, is a medication that can sometimes help to stimulate ovulation.

If abnormal function of the thyroid or pituitary gland is found to be involved as a causative factor, medications to replace the hormones normally produced by these glands can be useful. If a tumor or another structural abnormality of the reproductive or endocrine system is identified, a surgical procedure may be required to remove it.

All women with amenorrhea may benefit from healthy lifestyle modifications and this should be recommended in all cases, particularly if the woman has a low body weight. A healthy, balanced diet and regular, light exercise are often the most beneficial.

Throughout treatment, women with amenorrhea should have a strong support network to help them through the struggles related to the condition. It is important that affected women have a trusted person that they can talk about any issues honestly with, whether that be a friend, family member, counselor or psychologist.

References

http://emedicine.medscape.com/article/252928-overview#showall
https://medlineplus.gov/ency/article/001218.htm
http://www.aafp.org/afp/2006/0415/p1374.html
http://umm.edu/health/medical/altmed/condition/amenorrhea