Amenorrhea
… is the absence of a menstrual period.
Having regular periods is an important sign of overall health. Unless you are on a hormonal birth control, missing a period, when not caused by pregnancy, breastfeeding, or menopause, is generally a sign of another health problem.
How does menstruation work?
A complex system of hormones controls your menstrual cycle:
- An area in your brain called the HYPOTHALAMUS produces a hormone called GnRH.
- GnRH stimulates the PITUITARY GLAND which produces FSH (follicle stimulating hormone)
- FSH stimulates the OVARY.
- Every month your ovaries form multiple small cysts called follicles, an event which starts at the beginning of your menstrual cycle.
- Typically, one follicle grows faster than the others, becoming the dominant follicle that contains the egg, preparing it for release (ovulation).
- This dominant follicle produces estrogen.
- Estrogen stimulates the lining of the uterus called the endometrium preparing it for pregnancy.
Every cycle, these hormones prepare your uterus for a possible pregnancy. If there’s no pregnancy that cycle, you shed your uterine lining. That shedding is your period.
This is called:
The HYPOTHALAMIC + PITUITARY + OVARIAN control
There are many factors that can affect this control which can cause you to not have your period.
There are two kinds of amenorrhea: primary and secondary.
Primary amenorrhea – When you haven’t gotten your first period by age 15 or within five years of the first signs of puberty (such as developing breasts).
Primary amenorrhea can result from two main causes:
- Chromosomal or genetic conditions.
- Problems with the hypothalamus or pituitary gland.
- Structural problems with your organs, such as missing parts of your uterus or vagina or having an underdeveloped reproductive system.
Secondary amenorrhea – This occurs when a woman who once had regular periods experiences 6 months of no periods.
Causes of secondary amenorrhea include:
Natural causes
- Pregnancy is the most common natural cause of secondary amenorrhea.
- Other physiologic causes include breastfeeding and menopause.
Medications
- Certain birth control pills, injectable contraceptives, and hormonal intrauterine devices (IUDs) can cause amenorrhea. It can take a few months after stopping one of these types of birth control for the menstrual cycle to restart and become regular.
- Some medications, including certain antidepressants and blood pressure medications, can increase the levels of a hormone that prevents ovulation and the menstrual cycle.
Abnormalities of the uterus or scarring of the inside of the uterus.
Hypothalamic amenorrhea. This condition occurs when the hypothalamus, an area in the brain that regulates body processes, slows or stops releasing gonadotropin-releasing hormone (GnRH), the hormone that starts the menstrual cycle. Common characteristics of women with hypothalamic amenorrhea include:
- Low body weight
- Low percentage of body fat
- Very low intake of calories or fat
- Emotional stress
- Strenuous exercise that burns more calories than are taken in through food
Gynecological conditions, specifically those that lead to or result from hormone imbalances, may also have secondary amenorrhea as a main symptom.
- Polycystic Ovarian Syndrome (PCOS)
- Primary Ovarian Insufficiency – Fragile X describes a condition in which a woman’s ovaries stop functioning before normal menopause, sometimes around age 40. Fragile X results from certain changes to a gene on the X chromosome.
If you are missing monthly periods or not having your period, amenorrhea, this may be a symptom of a more serious health problem. It’s important to call for an appointment with one of our specialists at County Obstetrics & Gynecology.
Medical Conditions
- Thyroid Dysfunction
- Pituitary Gland Tumors
The providers at County Obstetrics & Gynecology have the knowledge, experience, and resources to accurately identify the cause of your amenorrhea. Our providers and will then discuss available treatment options and assists you in selecting treatment plan.