What is Amenorrhea? How to Treat Amenorrhea?

by Abbas Jahangir · June 22, 2024

In healthy women, with puberty, an egg cell matures in the ovaries every month and the menstrual cycle begins. With the beginning of this cycle, menstrual bleeding occurs every month, and this continues until the loss of reproductive ability with menopause at approximately 45-55 years of age. Although there is no pregnancy, breastfeeding or onset of menopause in women of reproductive age, the absence of menstruation is called amenorrhea. In amenorrhea, which can be confused with menstrual irregularity, the problem is not any irregularity, but the problem of not having a menstrual period at all. Although amenorrhea cannot be described as a direct disease, it may occur due to a disease that requires intervention or may cause problems for women who want to have a baby. For this reason, women who complain of amenorrhea should consult a gynecology specialist and undergo examination, and if a problem that requires intervention is detected as a result of the physician’s evaluations, they should receive treatment.

What is Amenorrhea?

Amenorrhea, in general terms, is when a woman does not have a menstrual period even though she has reached puberty or has not yet entered menopause. An alternative answer to the question of what amenorrhea means is the condition of having never had a menstrual period or having stopped menstruating, which is seen in post-adolescent, pre-menopausal women who are not pregnant, not breastfeeding, and women.

Amenorrhea is divided into two groups: primary and secondary, depending on the condition of never having had a menstrual period or having previously had a menstrual period but then cessation of menstruation. Although primary or secondary amenorrhea is usually caused by problems related to hormonal regulation, it can be caused by different reasons such as anatomical problems, gynecological diseases and benign or malignant cysts. In some cases, women who do not have any gynecological diseases or problems with their body anatomy and whose hormone levels are normal may experience menstrual problems.

What is Primary Amenorrhea?

Primary amenorrhea is the condition in which young girls have not yet menstruated despite the age of 15-16. In this case, menstrual bleeding does not start during adolescence and primary amenorrhea is suspected. Necessary examinations and tests should be performed on people who are 15 years old and have not yet had a menstrual period to determine whether there is any health problem that may underlie this condition. Hormonal disorders are the most common cause of primary amenorrhea.

However, reasons such as congenital anomalies, chromosomal disorders, anatomical problems such as the absence of a uterus and vagina, and underdeveloped reproductive organs may cause primary amenorrhea. Some problems related to the pituitary gland or hypothalamus, which affect the synthesis of hormones necessary for the onset of menstrual bleeding, and other than the reproductive organs, are also among the causes of primary amenorrhea, and detailed investigations into the cause of this condition must be carried out for treatment.

In some people, the hymen at the entrance to the vagina may not anatomically contain holes to allow menstrual blood to come out and may completely block the vaginal tract. In this case, menstrual bleeding accumulates in the vagina and causes serious health problems. When the necessary opening is created on the hymen with the help of a simple operation, menstrual bleeding begins and continues in a healthy way.

What is Secondary Amenorrhea?

Secondary amenorrhea, unlike primary amenorrhea, is the condition of not having a menstrual period after having menstruated before. Gynecological diseases, acute or chronic serious diseases, intense stress, extreme weakness, rapid weight loss, intense exercise, unhealthy diet, pituitary gland diseases or some medications are among the common causes of secondary amenorrhea.

A body mass index below 19, which is obtained when the body mass in kilograms is divided by the square of the height in meters, significantly increases the likelihood of secondary amenorrhea. Gynecological diseases such as polycystic ovary syndrome, ovarian and endometrial cysts, and premature ovarian failure are among some gynecological diseases that can lead to cessation of menstruation. Thyroid diseases can also affect hormonal balance and prevent menstruation.

Additionally, chemotherapy drugs, antipsychotic and antidepressant drugs, and some blood pressure and allergy medications can also cause secondary amenorrhea. It is normal for breastfeeding mothers not to have menstrual periods due to the suppressive effect of the prolactin hormone on ovulation, and this is not considered as amenorrhea. In women with an active sexual life, a pregnancy test should be performed before starting investigations for suspicion of amenorrhea.

What are the symptoms of amenorrhea?

The main symptom of amenorrhea is the absence of menstrual bleeding. However, various additional symptoms may be observed due to the effect of the problem causing amenorrhea. Although these symptoms vary depending on the underlying health problem, they commonly include:

Hair growth (hirsutism)
Headache
visual disturbances
Milk or discharge from the nipple
pelvic pain
Acne
Hair loss
Lack of breast development (in primary amenorrhea)

These symptoms, which can be seen in addition to amenorrhea, can give important ideas about the health problem that prevents menstrual bleeding. For this reason, it would be beneficial for patients who apply to health institutions for the treatment of amenorrhea to inform their physicians about the additional symptoms they experience.

How to Treat Amenorrhea?

The process for treating amenorrhea must begin with a definitive diagnosis. For this, first a pregnancy test is performed to rule out the possibility of pregnancy. During a gynecological examination performed by a physician, the vagina, uterus and ovaries can be examined in detail under ultrasound guidance. In secondary amenorrhea, detailed information can be obtained with vaginal ultrasound in women who have had sexual intercourse before.

In people who have not had sexual intercourse, abdominal ultrasound performed from the abdomen is used. Many conditions such as ovarian and uterine cysts and structural problems related to internal genital organs can be detected. In addition to the physical examination and ultrasound examination, some blood tests are needed. Generally, along with the pregnancy test, thyroid function tests, ovarian function tests, tests measuring the levels of female and male sex hormones and prolactin levels are also applied. Problems related to hormonal balance can be diagnosed with the help of these tests. Some hormonal imbalances, such as high prolactin, may be caused by benign tumors in the pituitary gland.

In the presence of such a situation, magnetic resonance (MR) examinations of the pituitary gland in the brain can be performed. If ovarian or uterine cysts are detected on ultrasound, it is possible to undergo tests called tumor markers, which provide preliminary information about whether the tumor is malignant or not. If suspicious results are obtained, biopsy and surgical operations should be resorted to. Likewise, ovarian cysts, which are benign but carry risks such as bursting or spraining, should also be removed by surgical operation.

In case of primary amenorrhea, follow-up may be recommended if no hormonal or anatomical problem or disease is detected. If there is a family history of late menstrual bleeding, this may be considered normal. In some chromosomal disorders such as Down syndrome and Turner syndrome, reproductive ability may not be possible. In such a case, amenorrhea is not a disease and does not require any intervention.

If anatomical problems are detected, surgical operations may be required. In secondary amenorrhea, if gynecological diseases or hormonal disorders are detected, treatment is applied accordingly. If there are reasons such as lifestyle problems, excessive exercise, and stress, patients are informed about the habits they need to change. If very thin people gain weight in a healthy way under the supervision of a dietitian and reach their ideal body mass, their hormonal levels usually return to healthy ranges and the menstrual cycle begins.

Apart from these, in case of amenorrhea caused by any disease other than the reproductive organs, patients can be directed to different medical units and receive information about practices for the treatment of these diseases. In drug-related cases, the treating physician should be consulted about different drug alternatives.

If you are of reproductive age and have not had a menstrual period for more than three months, even though you do not have a special condition such as pregnancy or breastfeeding, it would be beneficial for you to be examined by a gynecologist. By starting your treatment process, if necessary, according to your doctor’s recommendations, you can ensure that your diseases are controlled at an early stage and protect your health.