The absence of menstrual period in women of reproductive age is medically called ‘amenorrhea’. Based on the causes, amenorrhea can either be primary or secondary. The start of menstruation (menarche) varies in different females but if at the age of 16 years, she doesn’t have her first menstrual period (menarche) or if at the age of 14 years, she hasn’t developed any secondary sexual characteristics (like development of breast and pubic hair) and also hasn’t had her first menstrual period, then this is primary amenorrhea. If menstruation ceases for up to 3 months in a woman who has regular menstrual period or for up to 6 months in a woman with irregular periods, then this is secondary amenorrhea. Although this can also be the pattern in women who are nearing menopause.
Usually, primary amenorrhea is caused by problems in physiological development while secondary amenorrhea is often caused by hormonal problems. Below is a more elaborate detail on the causes:
- Physical malformations such as an imperforate hymen (the covering of the vaginal opening), absence of vagina and uterus (womb) and blockage of the vagina.
- Genetic factor such as a family history of amenorrhea and early menopause. It could also be caused by a defect in the chromosome (where genetic information of an individual is stored) as in the case of Turner syndrome (a defect whereby an individual has only one chromosome instead of the usual two). Androgen insensitivity syndrome is another genetic factor that can cause amenorrhea. It is a condition whereby an individual is genetically male but is born with female parts and also develops as a female.
- Problems in the glands producing hormones can be a cause as menstruation is dependent on hormones.
- Excessive exercise, extreme weight loss and stress can be a cause. This is because the menstrual period is dependent on energy, a reason why some women feel fatigue a few days before or during their period. And these three factors can cause your energy threshold to be very low.
- It can also be caused by being overweight and a sudden change in weight (either adding weight or losing weight) or poor diet as they all have effect on the hormones associated with menstruation
- Some contraceptives such as birth control medications (containing only progestogen) and intrauterine devices (IUDs) can cause amenorrhea as a side effect.
- Some medications such as antidepressants and antipsychotics. Also long term use of narcotics like heroin and cocaine can be a cause.
- Certain health conditions like celiac disease, polycystic ovarian syndrome and endometrial cancer.
- Cancer treatments like radiation and chemotherapy.
Apart from the absence of menstrual period, other symptoms might include the following, depending on the cause;
- Absence of secondary sexual characteristics like breasts
- Decrease in breast size
- Galactorrhea, which is the secretion of milk not associated with child birth. It is caused by excess secretion of the hormone prolactin that is responsible for breast development and milk production.
- Excess body hair growth including facial hair as of that in males
- Expression of menopausal symptoms like decreased libido, hot flashes, emotional outburst and headache.
- Osteoporosis (reduction in bone density usually in women due to reduced estrogen production, a hormone that is involved in menstruation).
A treatment plan for amenorrhea is based on the cause and not in all cases can amenorrhea be treated. In such a case, a patient will be guided on how to cope with the consequences of amenorrhea such as infertility. Surgery might be required to treat malformations and other physical causes. Amenorrhea that is caused by abnormal weight can be treated by change in lifestyle like eating healthy and engaging in less extreme exercise. This is usually effective in women with secondary amenorrhea. Although, some contraceptive pills like those containing only progestogen can cause amenorrhea, there are other contraceptive pills that can help in the return of menstruation (those containing both estrogen and progesterone). If you notice a drug you are using is affecting your menstrual period, seek the advice of your doctor and if you are addicted to the use of certain narcotics, seek help. Estrogen therapy can be administered in cases of low estrogen.
It is advisable to seek medical attention to know the cause of amenorrhea, this way, appropriate care and treatment can be carried out.
Oyewole Ibukun is currently a Medical student of Olabisi Onabanjo University. She has a passion for seeking knowledge with a creative, detail oriented and analytical mindset.