Menstruation, commonly known as menses, is the monthly bleeding of the uterus. Every month, the ovaries produce an egg that stays in the fallopian tube where it waits for a sperm to fertilize it. The ovaries also stimulate the inner lining of the uterus to become thicker in preparation for the implantation of the fertilized egg. However, when the egg is not fertilized by a sperm, implantation to the uterus does not happen and the inner lining of the uterus, along with the egg and some blood, is shed into the vaginal canal and out to the external environment. The woman experiences this bloody vaginal discharge every month.
In most women, menstruation happens every 21 to 35 days, lasting for about 2 to 7 days, and amounting to about 35 to 50 mL. Any deviation from this norm is considered abnormal.
- Menorrhagia is the term used to describe heavy or prolonged bleeding
- Hypomenorrhea is the term used to describe light bleeding
- Hypermenorrhea or polymenorrhea is the term used to describe frequent menstruation or menstruation intervals that are less than 21 days
- Oligomenorrhea is the term used to describe infrequent menstruation or menstruation intervals that are more than 35 days
- Amenorrhea is the absence of menstruation.
Amenorrhea (Absent periods)
Amenorrhea is defined as the absence of menstruation for three months in a woman who is in her reproductive age or the failure of menstruation to occur in a woman who has reached the age of 16. Amenorrhea can be a physiologic or a normal occurrence in women who are pregnant or who just gave birth, in women who are menopaused, in women who are about to reach menopause (perimenopause), and in women who are about to start puberty (prepubertal). Other than these four conditions, amenorrhea in a woman usually indicates an underlying medical problem.
Causes of Amenorrhea
There are two type of amenorrhea: primary and secondary.
Primary amenorrhea is the failure of menstruation to occur in a woman who has reached the age of 16. In primary amenorrhea, the menstruation never occurs at all. Primary amenorrhea is usually due to hormonal imbalance brought about by the following:
- Congenital abnormalities of the ovary
- Congenital abnormalities of the adrenal gland
- Tumors in the ovary
- Tumor in the brain (particularly in the hypothalamus or pituitary gland)
- Genetic or chromosomal abnormalities (Conditions that are present at birth, but may not be noticed until puberty)
- Eating disorder or weight loss
Secondary amenorrhea is the absence of menstruation for three months in a woman who is in her reproductive age. In secondary amenorrhea, a woman was previously having regular menses but it suddenly stopped for a long time. This can be due to the following reasons:
- Natural causes like pregnancy (most common), breastfeeding, and menopause
- Hormonal imbalance which could be due to:
- Ovarian cysts (PCOS or polycystic ovarian syndrome) or ovarian insufficiency/failure
- Brain tumors (in the pituitary (prolactin secreting) or hypothalamus)
- Genetic or chromosomal abnormalities
- Medications like oral contraceptive pills, other injectables, or chemotherapeutic drugs
- Weight loss or eating disorders
- Surgery such as the removal of ovaries and/or uterus
When to seek consult
Any woman who is experiencing amenorrhea should visit a gynecologist because amenorrhea often times point to an underlying condition. If you are experiencing amenorrhea, you should seek consult immediately if:
- You think you might be pregnant
- You are having abdominal pain especially in the lower abdomen
- You are having abdominal distention
- You are having headaches or blurring of vision
- You are losing weight
Because there are so many possible causes of amenorrhea, the diagnosis of its underlying cause can be quite complicated. A thorough history is very important. You can help your doctor get more information about your amenorrhea if you keep a menstruation diary where you record all the dates of your menstruation and all the symptoms that you experience. A comprehensive physical examination is also important. This includes evaluation of the development of secondary sexual characteristics like breasts, axillary hair, and pubic hair.
The most basic test in any case of amenorrhea is a pregnancy test. Other diagnostics tests can also be requested to check for hormone levels in the blood. These include tests for estrogen, FSH (follicle stimulating hormone), LH (luteinizing hormone), and TSH (thyroid stimulating hormone). Imaging tests can also be done to document any abnormality in the structure of the female reproductive tract. This can include hysterosalpingogram, ultrasound, or hysteroscopy. An MRI or CT scan of the brain or the abdomen can also be requested to check for presence of tumors.
The treatment of amenorrhea depends on the underlying cause. Generally, treatment of amenorrhea is directed at treating its underlying cause, if it is reversible or treatable. For example, amenorrhea that is due to eating disorders or weight loss is addressed by proper nutrition. Amenorrhea due to hormonal imbalances is addressed by treating the reason for the hormonal imbalance. If it is due to tumors, the tumor can be removed surgically. If it is due to abnormal functioning of the ovaries, hormonal treatments can be given like contraceptive pills. If it is due to hypothyroidism, thyroid hormone replacement medications are given. If the amenorrhea is due to stress, relaxation techniques can be practiced, and so forth.