Amenorrhoea

What does Amenorrhoea mean?

Amenorrhoea means a lack of menstrual periods. The condition is known as primary if the periods have never started at all, or secondary, when normal menstruation is interrupted for four months or more. Primary amenorrhoea is usually due to the late onset of puberty but less commonly it may be caused by a disorder in the reproductive or hormonal system.

Reasons for amenorrhoea

The commonest reason for secondary amenorrhoea is pregnancy. However, if the hormonal balance is interrupted for any other reason, this can also cause periods to be absent. For example, the suppression of hormonal production in the brain by suddenly stopping the birth control pill can lead to amenorrhoea for up to a year.

Many women who breastfeed have no periods until they wean their babies.

More seriously, amenorrhoea can be a side effect of being grossly underweight, such as with anorexia nervosa. (Abnormal weight control will be suspected if your weight is as much as 12kg below average body weight for your height and frame). Stress, certain chronic diseases such as thyroid disease or anemia, and long-term medication with drugs such as tranquilizers and anti-depressants can be other causes of amenorrhoea.

Amenorrhoea may also result from excessive physical activity -some highly trained athletes experience this condition.

Amenorrhoea is a permanent condition after the menopause or if you have your uterus removed in a hysterectomy.

Oligomenorrhoea

This is a condition when periods are regular but infrequent, that is not every 28 days. There is usually no problem as these irregular periods are preceded by ovulation. Oligomenorrhoea is commonly experienced as women approach the menopause.

Symptoms of amenorrhoea

Failure of the onset of menstruation and pubertal development – no development of sexual characteristics such as body hair, breasts and pelvic broadening

Periods stop quite suddenly or gradually cease with each successive month until the flow literally dries up

Is amenorrhoea serious?

Even though amenorrhoea does not necessarily mean you are ill, it does usually mean that you are not producing eggs and so cannot conceive.

Should I see the doctor?

The tendency to start menstruation late may be inherited, so if your mother started her periods late, don’t worry if you aren’t developing at the same rate as your friends. However, if you are 18 and have not menstruated, you should be seen by a doctor to check that there is no abnormality. If periods suddenly stop, pregnancy could be the cause, so see your doctor or do a pregnancy test first. In any case, see your doctor if your periods have been absent for nine months.

What will the doctor do?

If you have never had a period, your doctor will probably give you a physical examination and take a sample of blood to measure the level of pituitary hormones.

With secondary amenorrhoea, once pregnancy is excluded, a full medical examination should be undertaken by a specialist and if you are taking any long-term medications, these should be checked and stopped if necessary. Your doctor may arrange for you to have an X-ray to see if the gland that controls the secretion of hormones, the pituitary gland, is healthy.

Ultrasound scanning or laparoscopy may be undertaken to check your ovaries and pelvis. Hormonal therapy will determine if you are ovulating or not. Your doctor will probably only give you treatment if you want to become pregnant. This is most likely to be with fertility drugs or pituitary hormones.

What can I do?

The lack of menstural periods is not dangerous to your health and in most cases of amenhorrhoea, there is no cause for alarm; just be patient and your periods will start up naturally. You may need to change your lifestyle to correct any dietary or physical problems if this was found to be the cause. Remember that after childbirth and during breastfeeding, cessation of periods does not necessarily mean you cannot become pregnant, so you should take precautions if you don’t want another pregnancy right away.

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