Amenorrhea is absence of Periods (menses) in a woman who is not pregnant and in reproductive age, that is between 13 years to 45 years. It is a stressing condition for many women even though most cases are benign (not worrisome). Menstrual cycle lasts 21 to 28 days, if you miss periods for one full month (28 days) then you are considered to have amenorrhea.
There are many causes of Amenorrhea which usually need Gynecologist evaluation.
2 Types of Amenorrhea
Before mentioning causes of amenorrhea, it is important to mention classification of Amenorrhea into two main categories:
- Primary Amenorrhea: this is defined as failure to have menses until, and beyond age 15 in someone who has never had periods before.
- Secondary Amenorrhea: Cessation of menstruation for more than 3 to 6 months after they have been present, depending on whether they have been regular or not.
As you can see from the above definitions above, missing periods for one month or two is not something to worry about if you are not pregnant and have no other symptoms.
What is Primary Amenorrhea?
Women are expected to develop Female secondary sexual characteristics such as breast development, hips and pubic hair from the age 13. If they have those “female defining” characteristics but no menses at age 16, then a person is said to have amenorrhea.
If the lady does not develop secondary sexual characteristics and is 14 years old, she needs a Gynecologist evaluation for Primary amenorrhea.
What is Secondary Amenorrhea?
Secondary amenorrhea is very common and has two forms of definition:
If a woman has regular menses with no issues (having menses around same dates every month), then suddenly she misses periods for 3 months, she is treated as having secondary amenorrhea.
For ladies who have irregular periods, they must have amenorrhea for at least 6 months before they are evaluated to find the cause.
Causes of Amenorrhea
There are many causes of both primary and secondary amenorrhea. I will list the most common of all causes. Once you establish whether you have primary or secondary amenorrhea, the next step is to visit the physician who will do the initial evaluation. Pregnancy is the most common cause of Amenorrhea! Make sure you are not pregnant before worrying much.
Here are some of the causes of Amenorrhea:
- Hormonal contraceptives like Oral contraceptives and injection
- Medications like antihypertensives, Cancer chemotherapy, antipsychotics, antidepressants and anti-Seizure drugs. Even Opioids do cause amenorrhea.
- Thyroid disorders like Hypethyroidsm or Hypothyroidsm
- Polycystic Ovarian Syndrome (PCOS)
- Imperforate hymen
- Absent uterus
All the above mentioned causes and many more are diagnosed by a specialist (Gynecologist). The first test that is done is Pregnancy test, if negative then a further pelvic examination and ultrasound examination together with relevant blood tests are done to establish the cause.
Red Flags of Amenorrhea (when to worry)?
Visit a Physician even if you don’t fall on the above mentioned categories when you have one or more of the following
- A spontaneous Milky or Brownish vaginal discharge suggesting a Miscarriage (missed miscarriage)
- Impaired sense of smell suggests anaemia
- Visual field defects
- Virilization (development of sex characteristics that are usually found in men such as beard).
If you have any questions regarding Menstrual cycle, ask on the comments below.
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