Among women in their reproductive years, menstruation is acknowledged as a regular part of life. Although how frequently a girl or woman gets a period varies from one individual to another, still not having a period at all definitely signals that something is wrong.

The above-mentioned situation is referred to as ‘amenorrhea’ in medical terms. It is not a critical health condition but can act as a symptom of other genetic, hormonal, and structural disorders in women. 

In this guide, we will offer you a comprehensive overview of amenorrhea, including its causes, early symptoms, and treatment options, based on the latest findings from physicians worldwide. 

What is Amenorrhea?

Amenorrhea is a phase when you miss your usual menstrual period during the reproductive years. Specific genetic factors that may disrupt the regular functioning of the pituitary or hypothalamic gland can cause amenorrhea. 

In addition to family history, sometimes excessive exercise, unhealthy eating habits, and obesity may also lead to this issue among women. 

What are the Different Types of Amenorrhea?

Two types of amenorrhea symptoms coexist. These include:

1. Primary Amenorrhea

Primary amenorrhea symptoms occur when a girl has not experienced her first period by the age of 15 or within 5 years of her body showing the initial signs of puberty (like developing breasts). 

Mostly, if this is the case, then the chances are high that the person is born with amenorrhea-related genetic conditions or acquired abnormalities (medical conditions that arise after birth).

2. Secondary Amenorrhea

It refers to a condition in women who have been previously experiencing regular menstrual cycles but then suddenly cease getting periods for three months or longer. A few common reasons that may lead to this category of amenorrhea include:

• Pregnancy
• Lactation
• Stress
• Developing a chronic illness

What are the Causes and Risk Factors of Amenorrhea?

Some natural causes of amenorrhea are pregnancy, breastfeeding, and menopause. Apart from this: 

• Diverse lifestyle aspects like too much exercise, low body fat, high energy usage, or even eating disorders like anorexia nervosa or bulimia may disturb the normal menstrual cycle. 
• Psychological stress can disrupt normal hormone levels and interfere with the menstruation process. 
• While talking about hormonal imbalances, premature menopause, or health conditions like polycystic ovary syndrome (PCOS) can lead to amenorrhea. 
• In the latter case, a woman’s hormone levels normally stay high, which causes abnormal thyroid hormone secretions like hypothyroidism or hyperthyroidism, resulting in irregular periods. 

Finally, the following structural issues of female reproductive organs can also develop amenorrhea symptoms:

• Asherman’s Syndrome (it is an acquired condition where adhesions or scar tissues form on the inner walls of the uterus that can potentially cause menstrual problems).
• Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, or congenital absence of reproductive organs like the cervix, uterus or vagina
• Obstructed vagina can even lead to amenorrhea.

What are the Symptoms of Developing Amenorrhea?

Depending on the exact reason behind why you are experiencing amenorrhea, you may encounter additional symptoms along with the missing periods. Some of these signs are:

• Milky nipple discharge
• Hair loss and damage
• Headaches
• Excess facial hair
• Vision changes
• Acne issues
• Pelvic pain

However, some of the signs listed here may not be a definitive indicator of amenorrhea. According to expert suggestions, a woman 15 years or older who has missed three consecutive menstrual periods should consult a doctor. 

How is Amenorrhea Diagnosed?

When you see a doctor upon facing amenorrhea symptoms, they will conduct a pelvic examination to determine the health of your reproductive organs. As amenorrhea involves a complex set of hormonal issues, determining the root cause of the problem can be time-consuming. 

Therefore, healthcare providers mostly suggest more than one kind of testing: 

Blood Tests for Amenorrhea

A series of blood tests can be suggested, such as:

• Pregnancy Test: Your doctor will likely suggest this as the first test to rule out any natural cause of amenorrhea. 
• Thyroid Function Test: Next, the physician will want to monitor the levels of thyroid-stimulating hormone (TSH) in your blood. This is an effective method of determining whether your thyroid is functioning properly. 
• Ovary Function Test: Checking the quantity of follicle-stimulating hormone in a female’s blood can help determine whether her ovaries are properly functioning. 
• Prolactin Test: If the doctor sees low levels of prolactin hormone, then there can be chances of developing a pituitary gland tumour. 

If someone is experiencing excessive facial hair growth or a deepened voice, the doctor may also suggest a male hormone test.

Hormone Challenge Test

If someone is instructed to take this test, then they must stick to a hormonal medication for 7-10 days. The purpose of these medicines is to trigger menstrual bleeding. 

After a woman undergoes this test, the results can help her doctor assess whether her irregular periods are due to low oestrogen levels.

Imaging Tests for Amenorrhea

Based on the signs of amenorrhea and the results of the preliminary blood tests, a diagnosed person’s doctor may recommend scheduling one or more imaging tests. These cover:

• Magnetic Resonance Imaging (MRI): With this diagnosis method, physicians are able to get detailed pictures of soft tissues within the body. Therefore, those undergoing symptoms of amenorrhea may be required to appear for an MRI as doctors need to check for a pituitary tumour. 
• Ultrasound: In this test, images of internal organs can be produced with the help of sound waves. If a woman never experienced a period, then her doctor may recommend an ultrasound exam to find abnormalities in her reproductive organs. 

Finally, when each of the tests mentioned above does not reveal any solid causes of amenorrhea, then the concerned person may need to undergo a hysteroscopy. In this examination, a lighted tiny camera is passed through the patient’s vagina and cervix to examine the inner parts of the uterus. 

What are the Treatment Options for Amenorrhea?

The exact course of treatment is decided based on the underlying cause of amenorrhea: 

• For many, hormone therapies and birth control pills can restore their menstrual cycles. 
• If amenorrhea is happening due to pituitary disorders, then the person should be treated with medications. 
• If a structural blockage is disrupting the normal menstruation process, then surgery can be a viable option. 

Additionally, based on the condition, physicians and gynaecologists can often recommend: 

• Certain allergy medications 
• Contraceptives 
• Blood pressure drugs 
• Antidepressants 
• Chemotherapy (in rare cases)

How is Amenorrhea Treated Naturally?

If someone is missing their periods because of pregnancy, lactation or menopause, then they do not need any medical intervention to reverse the condition. 

In other cases, apart from the medicinal prescriptions, you can focus on the following:

• Practising stress management techniques
• Following a workout plan and diet that can help manage a healthy body weight 
• Changing exercise intensity (if that is draining you out)
• Going for hormonal treatment, as suggested by a certified healthcare provider

Here are some additional factors to consider:

• Surgery may be needed in some rare cases to treat amenorrhea. 
• To curb some side effects of the treatment, doctors may suggest undergoing oestrogen therapy and taking calcium and vitamin D supplements. 
• Strength training can help aid the side effects of amenorrhea by strengthening your overall pelvic muscles.  

How Long Does Amenorrhea Last?

In most cases, doctors can reverse the effects of amenorrhea by providing treatments that can restart periods regularly. 

Although it can take a few months for the normal menstrual cycle to be restored. It is best to consult with your healthcare provider to know what to expect from the treatment. 

FAQs About Amenorrhea

1. What are the first signs of amenorrhea?

Missing a period is one of the foremost signs of amenorrhea. In addition, some related symptoms can be hair loss, excess facial hair, lack of breast development, and vision changes. 

2. What is the best treatment for amenorrhea?

The best treatment for amenorrhea is determined by doctors after careful consideration of its underlying cause, like structural abnormalities in the reproductive system, hormonal fluctuations, or various lifestyle choices. Accordingly, treatment choices include: 

• Lifestyle changes 
• Medications 
• Hormonal therapy 
• Surgery (in rare cases) 

3. What deficiency causes amenorrhea?

Low vitamin D concentrations can disturb a woman’s regular menstrual cycle. Also, deficiencies in iron and vitamin B12 can contribute to late periods. 

4. Which fruit is good for amenorrhea?

Eating papaya can contract the uterus muscles and promote the oestrogen hormone production, which in turn induces menses or periods more frequently. 

5. Can you treat amenorrhea at home?

Yes, the adverse effects of amenorrhea can be prevented at home to a large extent. For this, you must bring in key lifestyle adjustments, such as consuming a healthy diet and doing moderate exercise regularly.

6. Is ashwagandha good for amenorrhea?

Although ashwagandha alone cannot regulate the menstrual cycle, its properties may significantly contribute to the process, potentially easing the symptoms of amenorrhea. The isoflavones and flavonoids of ashwagandha interact with the oestrogen receptors in a positive manner and may help induce periods. 

7. How common is amenorrhea?

Approximately 4% of women who are not pregnant, breastfeeding, or going through menopause may experience amenorrhea at some stage in their lives.

Conclusion

For most women experiencing amenorrhea, their monthly periods return if they undergo proper treatment. However, surgery may be needed in very rare cases if there is a pituitary tumour or uterine scar tissue. Therefore, the ideal decision is to visit a gynaecologist if someone misses their periods for three months or longer. 

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