Let’s face it, most women hate having periods. And why wouldn’t they? Periods are uncomfortable, messy, and painful for many. But as much as periods are hated, they are a very important part of a woman’s reproductive and overall health. So, keeping a close check on your cycles is extremely important. 

If you ever feel that your period has just packed its bags and disappeared, it could be a sign of amenorrhoea.  Amenorrhoea, a condition marked by the absence of menstruation, is a significant health concern affecting women of all ages in India. A study has reported that the prevalence of amenorrhoea was 21.3%  in Indian adolescent girls.  From young adolescents to women in their reproductive years, amenorrhoea can have far-reaching implications for physical and mental health.

What is Amenorrhoea?

Amenorrhoea is a medical disorder marked by a lack of menstruation. It can take two main forms: 

• Primary amenorrhoea occurs when menstruation does not begin by the age of 16, despite the existence of secondary sexual characteristics such as breast development and pubic hair growth. This can be caused by many different factors, including

• Hormonal imbalances

• Anatomical abnormalities

• Genetic conditions

• Secondary amenorrhoea occurs when menstruation stops for three or more consecutive cycles following a history of normal periods. It can be triggered by various factors, including:

• Stress

• Excessive exercise

• Eating disorders

• Certain medications

• Underlying medical conditions like polycystic ovary syndrome (PCOS) or thyroid disorders.

The menstrual cycle is regulated by a complicated interaction of hormones in the hypothalamic-pituitary-ovarian axis. Any interruption in this delicate balance can result in amenorrhoea.

A monthly cycle: Menstruation explained

Menstruation

Think of your menstrual cycle as a natural rhythm, a monthly journey your body takes. It's a complex dance of hormones, primarily oestrogen and progesterone. Every month, your body prepares for a potential pregnancy. It starts with the follicular phase, where a tiny egg starts to mature. Then, during ovulation, this egg is released and ready to be fertilised. If fertilisation doesn't happen, the lining of your uterus, where a fertilised egg would implant, sheds, causing your period. This cycle typically lasts around 28 days but can vary for each person. Sometimes, factors like stress, hormonal imbalances, or underlying health conditions can disrupt this rhythm, leading to irregular or missed periods.

What are the signs and symptoms of amenorrhoea?

Symptoms

While the most obvious sign of amenorrhoea is the absence of a period, it's not the only symptom. You might notice physical changes like unexpected weight gain or loss, excessive hair growth, tenderness in your breasts, or changes in your skin. Emotionally, you might experience mood swings, anxiety, or depression. 

Additionally, some women with amenorrhoea may also experience fatigue, headaches, or changes in their sleep patterns. If you're experiencing any of these symptoms, it's crucial to talk to your doctor for a proper diagnosis. Early intervention can help manage the underlying cause and alleviate associated symptoms.

What are the causes of amenorrhoea?

Amenorrhoea, the absence of menstruation, may stem from a variety of factors. Understanding these underlying causes is crucial for effective diagnosis and treatment.

• Physiological causes

Pregnancy is the most common cause of secondary amenorrhoea. Menopause, which occurs as women age, results from a decline in reproductive hormones and leads to the cessation of menstruation. Similarly, during breastfeeding, hormonal changes can suppress ovulation and temporarily halt menstruation.

• Hormonal imbalances

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder characterised by irregular periods, excess androgen levels, and often, polycystic ovaries. Conditions like hypothyroidism and hyperthyroidism may disrupt the hormonal balance necessary for regular menstruation. Issues with the pituitary gland, which controls hormone production, may lead to menstrual irregularities.

• Anatomical abnormalities

Primary amenorrhoea is often associated with congenital anomalies, including uterine birth defects. Conditions such as a hypoplastic uterus (an underdeveloped uterus) or Mayer-Rokitansky-Küster-Hauser syndrome (a congenital disorder where the uterus and parts of the vaginal canal are absent or underdeveloped) can impair normal reproductive development and prevent the onset of menstruation. These congenital abnormalities disrupt the reproductive system, requiring careful evaluation and management to identify the underlying cause. An imperforate hymen is a condition in which the hymen, a thin membrane that normally partially covers the vaginal opening, completely obstructs it. This can block menstrual flow and may lead to symptoms such as abdominal pain in adolescents.

• Lifestyle factors

Intense physical activity can interfere with the hormonal balance required for menstruation. Eating disorders like anorexia nervosa and bulimia nervosa may lead to significant weight loss and hormonal imbalances, resulting in amenorrhoea. Chronic stress may disrupt the hypothalamic-pituitary-ovarian axis, leading to irregular or absent periods.

• Medical conditions

Conditions like diabetes, inflammatory bowel disease, and certain autoimmune disorders may affect menstrual function. Certain medications may interfere with the menstrual cycle.

What are the risk factors for amenorrhoea?

A family history of menstrual abnormalities raises your chances of having amenorrhoea. Early puberty may be related to irregular menstrual cycles and early menopause. A history of eating disorders, such as anorexia nervosa or bulimia nervosa, might considerably raise the risk. Significant weight swings might disrupt hormonal balance and interfere with menstruation regularity. Chronic stress may hurt the hormonal system, resulting in menstrual abnormalities. Underlying medical conditions, such as PCOS, thyroid disorders, or pituitary gland dysfunction, may increase the risk of amenorrhoea.

How is amenorrhoea diagnosed and treated?

Correct diagnosis of amenorrhoea is the first step towards treating and managing the condition. If you’ve skipped your cycles and think something is off, contact a gynaecologist immediately. Some common tests that your doctor might suggest to identify the condition include: 

• Pregnancy test: Since pregnancy is the most common reason for missed periods, this is often the first test performed. 

• Medical history and physical exam: Your doctor will ask about your menstrual history, lifestyle, stress levels, and any underlying health conditions.

• Blood tests: To check hormone levels, including:

• FSH and LH (to assess ovarian function)

• Prolactin (to rule out pituitary disorders)

• Thyroid hormones (to check for hypothyroidism)

• Estrogen and Androgens (to detect hormonal imbalances)

• Imaging tests: Ultrasound or MRI may be used to check for structural abnormalities in the reproductive organs or pituitary gland.

• Endometrial biopsy: In some cases, a small tissue sample from the uterus is tested to evaluate the lining.

Treatment of amenorrhoea depends on the root cause of the condition and your overall medical history. Some of the most common treatment options would include lifestyle changes like managing stress, maintaining a balanced diet, and achieving a healthy weight can help restore periods. Hormone therapy and other medications may also be prescribed by your healthcare provider. Amenorrhoea treatment should be guided by a healthcare professional, so we encourage you to consult your doctor for the best course of action.

How can I prevent amenorrhoea?

Prevention

While there's no guaranteed way to completely prevent amenorrhoea, adopting a healthy lifestyle can significantly reduce the risk. Here are some tips:

• Maintain a healthy weight: Avoid extreme weight loss or gain. Eat a balanced diet rich in fruits, vegetables, and whole grains. Consult a nutritionist for personalised dietary advice.

• Manage stress: Practice stress-reduction techniques like yoga, meditation, or deep breathing exercises. Get adequate sleep. Prioritise self-care and find healthy ways to cope with stress.

• Regular exercise: Engage in moderate physical activity most days of the week. Avoid excessive exercise, as it can disrupt hormonal balance.

• Stay hydrated: Drink plenty of water throughout the day.

• Address underlying health conditions: Consult a healthcare provider for timely diagnosis and treatment of conditions like PCOS, thyroid disorders, or eating disorders.

• Seek medical advice for irregular periods: If you experience irregular periods or missed periods, consult a gynaecologist to identify any underlying issues.

Listen to the signals your body sends

Amenorrhoea, while a common concern, is often treatable. By identifying the underlying causes and adopting a healthy lifestyle, many women can regain regular menstrual cycles. However, it's crucial to remember that amenorrhoea can be an indication of more serious underlying health conditions. If you're experiencing amenorrhoea, it's essential to contact a doctor for a comprehensive evaluation. Early diagnosis can help identify the root cause and prevent potential complications. By prioritising your health, managing stress, maintaining a balanced diet, and engaging in regular physical activity, you can enhance your overall well-being and improve your chances of restoring regular menstrual cycles.

Frequently Asked Questions

FAQs

1. Is amenorrhoea a type of infertility?

Amenorrhoea is not necessarily a type of infertility, but it can be a symptom of underlying conditions that may affect fertility.

2. Can amenorrhoea be cured?

While amenorrhoea itself might not be cured, the underlying cause can often be treated, which may restore regular menstrual cycles.

3. Can stress or weight changes cause amenorrhoea?

Yes, both stress and significant weight changes can disrupt the hormonal balance and lead to amenorrhoea.

4. How can hormonal imbalances lead to amenorrhoea?

Hormonal imbalances can affect the typical functioning of the hypothalamic-pituitary-ovarian axis, which influences the menstrual cycle, leading to amenorrhoea.

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