Has your monthly period stopped? Let's learn about amenorrhea.

Do you sometimes think, "Oh, I haven't had my period this month yet?" Or maybe one of your daughters or sisters has reached puberty and hasn't yet reached puberty? There is a medical term for this type of delayed or complete absence of menstruation. It is `(Amenorrhea)` . Sometimes this can be normal, but sometimes it can be a sign of an underlying disease. So today, let's talk about `(Amenorrhea)` in detail, as if we were talking to a friend.

What is menstruation? How does it actually happen?

Simply put, menstruation is part of the process by which a girl's body prepares to conceive a child each month. It involves a lot of chemicals called hormones . Think about it, it's like a complex plan.

There is a small but very important gland in our brain called the `(Hypothalamus)`. This gland controls another gland called the `(Pituitary gland)`. This `(Pituitary gland)` is what gives the signals to the `(Ovaries)` to release an egg (`(Ovulation)` or ovulation).

Your ovaries are where eggs are stored and produced. They also produce two hormones that are very important for a girl: estrogen and progesterone.

Under the influence of these hormones, the inner lining of your uterus (we call it the endometrium) gradually thickens. It's like preparing a comfortable mattress for the baby to sleep in if it arrives.

However, if a baby is not conceived that month, the thickened uterine lining is no longer needed. Then it is shed from the body. That is why we call it 'menstruation' or 'periods'. For this process to happen properly, the organs called `(Hypothalamus)`, `(Ovaries)` and `(Uterus)` must work properly.

What are the main types of amenorrhea?

There are two main types of `(Amenorrhea).` Let's see what they are.

1. Primary amenorrhea - (Primary amenorrhea)

This refers to those who have never had their periods by the age of 15. Or, if they have not had their periods for five years after the first signs of puberty (such as breast development) have begun, this also falls into this category. This can be caused by genetic conditions that are present at birth or by certain conditions that develop later in life.

2. Secondary amenorrhea - (Secondary amenorrhea)

This is when a person who previously had regular menstrual periods suddenly stops menstruating for three or more months . If a person's menstrual cycle was previously irregular, stopping menstruating for six months is also considered ``Secondary amenorrhea''. The most common causes of this are:

• Pregnancy
• Lactation
• Severe stress
• Having a chronic illness

How common is amenorrhea?

In fact, it is estimated that about one in four women who are not pregnant, breastfeeding, or have not gone through menopause will experience amenorrhea at some point in their lives. So it's not that uncommon.

What are the symptoms of amenorrhea?

The main symptom is the absence of menstruation. However, in addition to that, other symptoms may appear depending on the cause of `(Amenorrhea). For example:

• A sudden feeling of intense heat (`Hot flashes`).
• Nipples leaking milk even without a baby.
• Vaginal dryness.
• Frequent headaches .
• Vision changes.
• Excessive acne .
• Excess hair growth on the face and body.

These symptoms don't occur in everyone, but if you have these things, it's a good idea to see a doctor and talk to them.

What are the causes of amenorrhea?

The causes of the two types of amenorrhea are also different. Some of the causes are natural, while others may be a sign of a medical condition.

Natural (common) causes of cessation of menstruation:

• Pregnancy: This is the most common cause of secondary amenorrhea. When a baby is conceived, the body knows that it doesn't need to release another egg or have a period. So menstruation stops.
• Lactation amenorrhea: Many mothers do not have their periods while breastfeeding.
• Menopause: Women's periods usually stop permanently between the ages of 45-55.
• If you have had surgery to remove your uterus or ovaries: You will not have your period at that time either.

Common causes of primary amenorrhea:

If you have never had your period by the age of 15, it could be due to:

• Chromosomal or genetic problems: These are conditions that are present at birth. For example, conditions like Turner syndrome can affect the development of the reproductive system.
• Hormonal problems caused by problems in the brain or pituitary gland: These may prevent the ovaries from releasing the hormones needed for proper function.
• Structural problems with the reproductive organs: Things like missing parts of the uterus or vagina, or underdeveloped reproductive system.

Common causes of secondary amenorrhea:

If you have been menstruating regularly before and suddenly stop menstruating for three months or more, it could be due to the following factors:

• Some birth control methods: For example, the shot called Depo-Provera®, some intrauterine devices (IUDs), and some types of birth control pills.
• Chemotherapy and radiation therapy for cancer.
• If you have had previous surgery on your uterus and have scar tissue: for example, after a procedure such as a Dilation and Curettage (D&C).
• Severe stress: Think about how much stress you were under when you were taking your A/L exams or when you first started a new job. Things like that can also cause your period to be late.
• Poor nutrition: When the body does not receive the proper nutrition it needs, hormonal function can be disrupted.
• Big changes in body weight: It's okay to suddenly become very thin, or it's okay to become very heavy.
• Extreme exercise routines: Some girls, thinking they need to lose weight, don't eat properly, and work out at the gym all day long. One reason for this is that they exercise more than their bodies can handle.
• Some medications.

In addition, certain medical conditions can also cause ``Secondary amenorrhea``:

• (Primary ovarian insufficiency - POI): This is when the ovaries stop functioning before the age of 40.
• Hypothalamic amenorrhea: The cessation of menstruation due to a problem in the functioning of the hypothalamus in the brain.
• Pituitary disorders: For example, pituitary tumors or overproduction of the hormone prolactin.
• Hormonal imbalances such as polycystic ovary syndrome (PCOS), adrenal disorders, or hypothyroidism .
• Non-cancerous or cancerous tumors of the ovaries (`Ovarian tumors`).
• Obesity.
• Chronic diseases: For example, kidney disease or inflammatory bowel disease (IBD).

What are the risk factors for amenorrhea?

Some people are more likely to develop this condition. Risk factors that affect it include:

• If someone in your family has had amenorrhea, or has had early menopause.
• Having a genetic or chromosomal condition that affects the ovaries or uterus.
• Obesity or weight loss.
• Having an eating disorder.
• Excessive exercise.
• Following an unhealthy diet.
• Severe mental stress.
• Having a long-term illness.

Can amenorrhea cause complications?

Amenorrhea is not life-threatening. However, some of the conditions that cause it can cause long-term complications. Therefore, if your period has stopped, it is important to see a doctor to find out the cause. A person with amenorrhea is more likely to experience the following:

• Osteoporosis (thinning of the bones) or cardiovascular disease: This is caused by a decrease in the hormone estrogen.
• Difficulty having children or infertility.
• Pelvic pain: This is caused by a structural problem in the reproductive organs.

How to diagnose (Amenorrhea)?

If you have missed your period for three months in a row, see a doctor. He or she will ask you about your symptoms, your family history, and your menstrual cycle. Then, they will perform a physical exam and a pelvic exam.

What tests are done for amenorrhea?

The doctor may need to do some tests, such as:

• A pregnancy test.
• Blood tests: Check hormone levels and check for thyroid or adrenal gland diseases.
• Genetic testing: If you have primary ovarian insufficiency (POI) and are under 40 years of age.
• (MRI) Scan: If there is a suspicion of a problem with the pituitary gland.
• Ultrasound scan: If there is a suspicion of a problem with the ovaries or uterus.

Is it important to keep track of my menstrual cycle?

Yes, definitely. Finding the cause of amenorrhea can sometimes be a little difficult. Unless there is an obvious cause, such as pregnancy or menopause, your doctor will ask you to keep a diary of changes in your menstrual cycle. This can be a great help for the doctor in making a diagnosis.

Write down the following in a small notebook or on an app on your phone:

• How long have you had your periods?
• When did you last get your periods?
• What medications do you take?
• Have you made any changes to your diet or exercise?
• Are you feeling stressed or anxious?

How is Amenorrhea treated?

If your period has stopped due to menopause, lactation, or pregnancy, no special treatment is required.

In other cases, the treatment you receive will depend on the cause of your amenorrhea. Accordingly, treatments may include:

• Following a diet and exercise plan that helps you maintain a healthy weight that suits you.
• Stress management techniques .
• Changing the level of exercise (if you are doing too much, reduce it, if not, increase it a little).
• Hormonal treatment: As prescribed by the doctor.
• Surgery: This is done very rarely.

In addition, the doctor may recommend some treatments to relieve the side effects of amenorrhea:

• Estrogen therapy: Reduce hot flashes and vaginal dryness.
• Calcium and Vitamin D supplements: Keep bones strong.
• Strength training: Weight lifting or exercises that strengthen muscles.

Do I need surgery for amenorrhea?

No, surgery is not necessary in most cases. However, your doctor may recommend surgery in the following cases:

• If there is a physical change that prevents blood from flowing out of the vagina (e.g., vaginal septum or imperforate hymen).
• If you have a pituitary tumor.
• If there is scar tissue in the uterus.

How long will amenorrhea last? Will menstruation start again?

Amenorrhea can often be cured. With treatment, your periods should start to come back on schedule . Sometimes it can take a few months for your period to return, but most people do. Talk to your doctor about what you can expect with treatment.

Usually, menstruation will start again once the underlying cause is treated. However, it may take some time for it to become regular again.

Sometimes, you may never have your period due to a health problem. If that's the case, your doctor will talk to you about your options if you want to have a baby.

Can amenorrhea be prevented?

Good health habits can help prevent some of the causes of ``secondary amenorrhea.`` Try these things:

• Follow a healthy diet and exercise plan that suits you.
• Be aware of your menstrual cycle (so you'll know right away if you miss a period).
• Keep regular gynecological appointments , including a pelvic exam and a Pap test.
• Get enough sleep .

When should you see a doctor about amenorrhea?

If you have missed your period for three months in a row, you should definitely see a doctor. Also, if you miss a period and have any of the following symptoms, see a doctor:

• Problems with balance, coordination, or vision (these could be signs of a serious condition).
• Milk secretion from the breasts even without having a child.
• If you notice unwanted hair growth on your body.
• If you are over 15 years old, but have not yet had your first period.

What else should I ask the doctor?

When you go to the doctor, don't forget to ask these questions:

• What is the reason for my amenorrhea?
• What treatment options do I have? What are the pros and cons of each?
• Do I need to see an endocrinologist for hormone therapy?
• Can I get pregnant even if I have `(Amenorrhea)`?
• After my period starts again, can I get amenorrhea again?

Is it normal to experience amenorrhea after stopping birth control pills?

Yes, some people may experience a missed period (post-pill amenorrhea) after stopping birth control pills. This is because your body is "getting used to" producing the hormones needed to ovulate and have a period again. It can take up to three months for your body to start menstruating again. If you still haven't had your period for four to six months after stopping the pill, talk to your doctor.

Is amenorrhea a type of infertility?

No, amenorrhea is not a type of infertility. However, the absence of menstruation can make it impossible to get pregnant. If you are hoping to have a baby, and your menstrual cycle is irregular or has stopped, see a doctor for advice.

Finally, this is what I have to say to you (Take-Home Message)

If you are over 15 years old but have not yet started menstruating, or if you have previously had regular periods and now have stopped, don't panic, but definitely see a doctor. Amenorrhea is usually a sign of a treatable condition. Once your doctor finds out the cause of your missed periods, you can get treatment to help your menstrual cycle return to normal. You may need to make some lifestyle changes or take hormone therapy. The most important thing is to talk to your doctor about this and get the right advice. Don't worry about it alone.

` Amenorrhea, cessation of menstruation, monthly menstrual cycle, loss of periods, primary amenorrhea, secondary amenorrhea, hormonal imbalance