So even though you're used to it and have access to super absorbent and comfortable organic menstrual products, sometimes your first reaction is to roll your eyes when you see your period has arrived? And bleeding, and cramps, and cravings. But still… you kind of enjoy it a little, don't you? It's a sign that things are working normally in your body. What we cannot say about amenorrhea.

It may sound good to get rid of bleeding every month, but the absence of periods - because that's amenorrhea - more often than not indicates a hormonal imbalance or a more serious health problem. Let's see everything we should know about amenorrhea, when it's a cause for concern and when you need to see a specialist.

What is amenorrhea?

Amenorrhea is a disorder of the menstrual cycle and means the absence of menstruation, or its absence for several consecutive months. Depending on when amenorrhea occurs, it can be of two types:

• Primary amenorrhea : that is, you have never had your period, and at the age of 15 you have not yet had your first period.

• Secondary amenorrhea : occurs at some point in life, in women who have already started their menstrual cycle, and consists in the delay or lack of menstruation, i.e. menstruation suddenly stops coming for 3 or more consecutive months. The most common cause of secondary amenorrhea is pregnancy, but it is not the only one - we tell you what the other causes can be.

Amenorrhea: Causes

The reasons for the absence or delay of the cycle can be very varied. In turn, they differ depending on the type of amenorrhea.

Primary amenorrhea is often based on hormonal disorders or various anatomical problems in the development of the vagina, uterus or hymen. Problems with the hypothalamus, genetic problems such as Turner syndrome or delayed puberty can also be causes of primary amenorrhea.

While secondary amenorrhea can be caused by pregnancy, as I said above, but also by certain pills, stress, hormonal problems, sudden weight loss or other health problems. Primary ovarian failure, polycystic ovary syndrome, brain/hypothalamic problems, or kidney failure can also be causes of secondary amenorrhea.

Below we talk about some of the most common causes of amenorrhea, as well as when it is and when it is not normal for your period to be late or stop suddenly.

Natural amenorrhea

There are cases when it is normal for menstruation to stop, and we call these situations natural amenorrhea. We are talking here about conditions such as pregnancy. When you get pregnant, one of the first signs is missing your period, and that's perfectly normal.

Likewise, amenorrhea is normal during breastfeeding, when prolactin (the hormone that contributes to the production of breast milk) prevents ovulation and the return of the normal menstrual cycle. That's why if you breastfeed it is possible that even a year will pass before the amenorrhea passes and the periods return.

And, of course, we are talking about amenorrhea as a natural process in the case of menopause, which is basically defined by this: the end of the menstrual cycle and the cessation of periods. After the age of 40-50 (sometimes even sooner), amenorrhea of 12 months is classified as menopause.

Contraceptives

You already know that birth control pills, or birth control pills, directly affect your hormone levels and menstrual cycle. If you don't know, let's talk: I blogged all about birth control pills a while ago.

So, another very common cause for the absence of menstruation can be starting a treatment with contraceptives, until the body gets used to the synthetic hormones and the menstrual cycle is regulated.

There are also cases where people taking contraceptives simply miss their periods. It can happen with both oral and injectable or implanted ones. Even some types of IUDs can lead to amenorrhea, and even after stopping use, it may take some time for ovulation and periods to return to normal.

Various medicines

Have you ever wondered if paracetamol stops your period? The answer is no, but there are plenty of other drugs that do. Among the pills whose administration can lead to amenorrhea are:

• Antipsychotics and antidepressants

• Medicines to treat allergies

• Blood pressure treatments

• Chemotherapy to treat cancer.

Lifestyle

• The weight

• Excessive physical exercise

• The stress

Is there any health problem where lifestyle is not one of the main causes? Daily activity, stress level, diet, body mass, physical exertion all influence your immune system and health in many ways, and the reproductive system and menstrual cycle are no exception. So, sometimes lifestyle factors such as:

• Stress : prolonged periods of stress can cause temporary disorders of the hypothalamus, which we told you above can cause amenorrhea. The hypothalamus is actually a part of the brain that controls the hormones that regulate your menstrual cycle, and obviously ovulation and menstruation can stop when this hormone level is out of balance. As a rule, shortly after the disappearance of these stress factors, the cycle returns to normal.

• Low body weight (underweight) : the natural production of hormones and implicitly many hormonal functions can be interrupted or unbalanced by too little body weight. 10% below normal weight is considered low body weight, and can influence ovulation. So the risk of amenorrhea is even higher in women who experience anorexia, bulimia or other eating disorders.

• Increased body weight (overweight or obesity) : at the opposite pole are the situations of a high body weight, which comes with a greater risk of irregular cycle and menstrual irregularities. Obesity is often associated with polycystic ovary syndrome, a problem that can lead to cessation of menstruation and amenorrhea.

• Excessive physical activity : intense and prolonged physical exertion can lead to very high energy consumption and a low body fat percentage, factors that can interrupt the menstrual cycle. That's why people who train several times a day or practice a sport that requires heavy and tiring training (eg: gymnastics, ballet) can face amenorrhea. It is recommended that girls and women who find themselves in this situation consult a sports medicine specialist to create a personalized plan and prevent such disorders.

Hormonal imbalance

Hormonal balance is the basis of a normal menstrual cycle. Estrogen and progesterone are two reproductive hormones produced in the ovaries that have a direct influence on ovulation.

So hormonal imbalance is among the most important causes of amenorrhea, and there are several health problems that can cause it:

• Polycystic ovary syndrome (PCOS) : naturally, throughout the menstrual cycle, hormones fluctuate (hence mood swings, food cravings, etc.). But in case of PCOS, the hormone level is higher and constant. In the absence of normal fluctuations, ovulation may not occur and thus amenorrhea occurs.

• Thyroid dysfunctions : Menstrual cycle irregularities - including amenorrhea - can be a result of thyroid problems, both hypothyroidism (an underactive thyroid gland that produces too few thyroid hormones) and hyperthyroidism (an enlarged thyroid gland that produces excess thyroid hormones).

• Tumor at the level of the pituitary gland : problems at the level of the pituitary gland (pituitary gland) can also cause delays in menstruation, because they influence the hormones responsible for regulating the menstrual cycle. So a benign (non-cancerous) tumor such as a prolactinoma can be a cause of amenorrhea.

• Premature menopause : as we said above, amenorrhea is normal in the case of menopause, which occurs naturally after the age of 40-50. But there are also cases when the release of eggs stops before the age of 40, a situation called premature menopause and in which menstruation stops and amenorrhea occurs earlier.

Problems and anomalies at the level of the neck

Last but not least, anatomical problems in the reproductive organs can lead to amenorrhea, and in this category we include:

• Uterine scarring : After a curettage, caesarean section or treatment for uterine fibroids, scar tissue can build up in the lining of the uterus, which prevents it from being removed normally through menstruation and can lead to amenorrhoea. The condition is called Asherman's syndrome.

• Lack of reproductive organs : is one of the major causes of primary amenorrhea, because certain problems occurred during the development of the fetus. The result is that the girl was born without certain sexual organs (ex: vagina, cervix or uterus), which is why the reproductive system cannot fully develop and it is impossible for the menstrual cycle to occur during life.

Structural abnormalities of the vagina: If there is an anatomical abnormality (for example, a membrane) that blocks the vaginal canal, it is possible that the bleeding cannot visibly pass the uterus or cervix and cannot be eliminated.

Symptoms of amenorrhea

According to the definition, amenorrhea is manifested by the absence of menstruation. Depending on the cause from which it started, it can also be accompanied by other signs and symptoms, among which :

• Pelvic pains
• Headaches
• Acne
• Excess facial/body hair
• Hair loss
• Vision problems
• Milky discharge from the nipples
• Excessive sweating and hot flashes
• Vaginal dryness.

When you should go to the doctor

As soon as you realize that you suffer from amenorrhea. In most cases, unless you are pregnant or menopausal, amenorrhea is not normal. Therefore, if you are 15 years old and you have not had your first period yet, or if suddenly 3 consecutive months pass without a period without a natural reason, go to a gynecological consultation as soon as possible to find out the cause and find a solution.

All the more, a gynecological consultation is recommended if amenorrhea is also accompanied by other symptoms listed above. Schedule a consultation as soon as possible if:

• You notice milk leaking from your breasts even though you haven't given birth recently;

• You notice excessive hair growth on your body or face;

• Vision or balance problems occur.

What questions should I ask my doctor?

We're sure you have a lot of questions running through your mind if you're suffering from amenorrhea, and it's normal to be confused. Why has it never occurred to you even though you are already 15 and all your friends have already had their first period? Why did your period suddenly disappear? Are there pills to induce periods? What can you do to get your period back?

Menstruation is natural, and when it's non-existent or suddenly disappears, it's normal to wonder what's wrong. Well, your doctor is the one who can help you find all the answers, so he is the one to ask. All! Everything that worries you. Here are some questions to get you started (but of course, if you're also concerned about other things related to your reproductive health, the list can go on for many more points):

• What is the cause of amenorrhea ?
• Can I still get pregnant if I have amenorrhea? Is it possible for me to face infertility because of this?
• What treatments are there for amenorrhea?
• What is the best solution for me, and what are its advantages and disadvantages?
• Do I need to see an endocrinologist for hormone treatment?
• Did my period stop because I stopped taking birth control pills?

How do we diagnose amenorrhea?

The gynecologist is the one who makes the diagnosis and determines the cause. To do this, he will ask you how many months your period has stopped, if you have any other symptoms, what is your medical history and other details about your menstrual cycle (whether it is regular or irregular, if you have suffered from amenorrhea or other irregularities menstrual periods in the past etc.). A physical examination will also be needed for an accurate diagnosis.

Blood tests

In addition to the gynecological consultation, the doctor may also request other genetic tests and blood tests to determine the exact cause of amenorrhea and to choose the best treatment for you. The hormone level can be observed in the blood and thus disorders of the adrenal or thyroid glands can be detected. So it is also possible to do tests:

• Pregnancy : to eliminate the possibility that pregnancy is the reason why your period is late, in which case amenorrhea would be normal. We talked more about pregnancy tests HERE .

• For thyroid function : the level of thyroid-stimulating hormone TSH can be measured in the blood, which reflects whether the thyroid is working properly.

• For ovarian function : similarly, the level of follicle-stimulating hormone (FSH) is measured in the blood to determine if everything is normal in the ovaries.

• Of prolactin : the level of prolactin in the blood is measured, which can indicate problems with the pituitary gland if it has a very low value.

• Of male hormones : it is an investigation that determines the level of male hormones in the blood, and is done when you notice the excessive growth of facial or body hair, or the thickening of the voice.

Imaging investigations

MRI investigations and ultrasound scans are other additional tests that may be done to diagnose amenorrhea and its cause. They can help detect problems in the pituitary gland or reproductive organs (ovaries, uterus).

Treatment for amenorrhea

Natural amenorrhea , i.e. the absence of menstruation during pregnancy, breastfeeding or menopause, should not be treated. You can rest easy, it is perfectly normal not to have periods during these periods of life.

For the other types of amenorrhea, treatment will be given depending on the cause and medical history. For example, if the factor causing your absence of menstruation is:

• Stress, it is recommended to prioritize rest and practice relaxation, meditation and stress management techniques.

• Sedentary lifestyle or unhealthy diet, it is recommended to follow a nutritional and training plan as balanced as possible, in order to reach the healthiest possible physical activity and body mass.

• Excessive training, it will be recommended to reduce the level of physical effort.

• A hormonal disorder, hormonal treatments will be prescribed to restore the balance, etc.

Operation in case of amenorrhea

Very rarely, there are cases when the only solution to get rid of amenorrhea and have periods is surgery. The doctor can intervene surgically when there is an anatomical problem such as a cyst or a tumor in the uterus, ovaries or pituitary gland. Once this tumor is removed, periods should return to normal.

Risk factors for amenorrhea

Risk factors for amenorrhea are primarily related to lifestyle and medical history. Thus, you are more prone to this problem if you have:

• A lifestyle with excessive stress
• Eating disorders
• A diet poor in nutrients
• A body mass that is too low or too high
• An excessive or too intense training plan
• Family members with a medical history that includes amenorrhea or premature menopause
• Genetic problems affecting your reproductive organs (uterus or ovaries)
• A chronic disease.

Complications in case of amenorrhea

Although amenorrhea is not, most of the time, dangerous in the sense that it does not threaten your life, it does threaten your quality of life. Depending on its causes, untreated amenorrhea can lead to long-term complications:

• Pelvic pain : when the cause is anatomical, that is, a problem related to the structure of the reproductive organs.

• Cardiovascular problems or osteoporosis : when the cause is a low level of estrogen.

• Infertility or difficulty getting pregnant : because amenorrhea means that there is no ovulation and reproductive function is affected.

It is essential to understand that the menstrual cycle is a natural and normal function that shows that your body is working properly. As good as it may sound to get rid of the monthly visits of menstrual bleeding, their absence is not normal and means that there is an imbalance in the body. Amenorrhea can indicate a more serious health problem, and that's why it's important to see a doctor as soon as possible for diagnosis and treatment.

Frequently asked questions about amenorrhea

Here we are among friends. Just because we've covered all the main topics related to amenorrhea, doesn't mean you can't ask us other questions. In fact, this is exactly what you do when you talk to a friend: she tells you as much useful information as possible, and then you ask those last questions that bother you.

That's what we do too: at the end of the article, we try to give you those answers that you may not have received in the rest of the article, but which we know you would like to know.

How long does amenorrhea last?

It is considered amenorrhoea when you have never had a period or when you have not had it for 3 consecutive months. And when we talk about the time it takes for the cycle to return to normal, it all depends on the cause and how quickly you seek the help of a specialist:

• Amenorrhoea during pregnancy and breastfeeding lasts until childbirth, respectively the cessation of breastfeeding, after which menstruation will return shortly.

• Amenorrhea due to menopause means the cessation of the menstrual cycle, meaning that menstruation will not return.

• In the case of secondary amenorrhea, most of the time it can be treated and therefore lasts until treatment is started. This means that the sooner you get to a gynecological consultation for diagnosis and treatment, the shorter the amenorrhea will last. It may take a few months for treatment to show results, but if you follow your doctor's advice, eventually your periods will return and your menstrual cycle will settle down.

Can I get pregnant if I have amenorrhea?

It may be more difficult to get pregnant if you have amenorrhea, but it is not impossible. As a rule, the absence of menstruation indicates that there was no ovulation, and without ovulation a pregnancy cannot occur. However, it is possible for ovulation to occur, especially when amenorrhea has a hormonal cause, so the possibility of getting pregnant is not completely ruled out.

The best example is after giving birth: while breastfeeding, even if you haven't had your period yet, it's still possible to get pregnant even just 4 weeks postpartum.

Once I get my period again, can I have amenorrhea again?

Yes. Any hormonal imbalance or major life change can affect your lifestyle, and it's important to always take care of your body to keep your periods coming regularly. For example, even if your period returned after a stressful period, it may disappear again if another period of chronic stress follows. Likewise in the case of too low body mass, pregnancy or hormonal imbalances.

Is it normal to have amenorrhea after stopping the birth control pill?

If this has happened to you, don't worry: you're not alone, and it's quite common to experience a temporary absence of periods (even up to 3 months!) after stopping the pill! It's just your body that needs time to start naturally producing the hormones you need for ovulation and menstruation again.

There is even a name for this problem, it is called post-pill amenorrhea. According to research, about 3-6% of women may experience amenorrhea after they stop taking birth control pills, and the risk increases even more if the menstrual cycle was irregular. However, if the period is missing for more than 4-6 months, talk to the specialist doctor.

Is amenorrhea a type of infertility?

No, amenorrhea does not automatically mean infertility. But the lack of menstruation - and implicitly ovulation - can lead to the impossibility of getting pregnant. So discuss this with your gynecologist if you want a pregnancy, but your periods are absent or irregular.