amenorrhea

Definition

Amenorrhea is the absence or cessation of menstruation in women of childbearing age. There are two types of amenorrhea: primary and secondary amenorrhea.
Primary amenorrhea occurs in young adolescents. We denote two particular situations:
– The girl does not menstruate at the age of 14 and does not show the development of secondary sexual characteristics (breasts, body hair, the distribution of fat on the hips).
– The young woman does not menstruate at the age of 16, but has a normal development of secondary sexual characteristics.
Secondary amenorrhea is the absence of menstruation for more than 3 menstrual cycles or 6 months in adult women who already menstruate.

Epidemiology

Amenorrhea is a natural consequence of breastfeeding, pregnancy and menopause. In addition to the three cases, 3 to 4% of women suffer from amenorrhea due to an underlying health problem, such as eating disorders or endocrine disorders.

Causes

Natural causes of amenorrhea

– Pregnancy is one of the main causes of amenorrhea. Often, without prior testing, this can be the main cause for sexually active women. Any woman with a period of more than eight days late should take a pregnancy test.

– Breastfeeding causes amenorrhea (although ovulation can still occur, unless the baby is only nursing and the baby is less than six months old.). It is the secretion of prolactin (hormone of lactation and development of the mammary glands), which induces amenorrhea. In case of pituitary tumor, this hormone can be produced in high doses, causing amenorrhea to occur.

– Delayed puberty (not severe): The age of puberty depends on ethnic origin, diet, geographic location and general health status. If secondary sexual characteristics are present, no investigation is necessary until age 16 (see description and statistics of amenorrhea).

– Menopause occurs between 45 and 55 years of age and causes a gradual decrease in menstruation, due to changes and decreases in female hormones (estrogen, progesterone).

“Artificial” or pathology-related causes

– Hormonal contraceptives . The use of a hormonal contraceptive can cause a withdrawal bleed. This is not a real period. In some women, in whom the normal cycle was already flawed, the use of hormonal contraceptives for a prolonged period can cause a reduction and even a cessation of menstruation. Discontinuation of contraceptive use, especially among women whose menstruation (prior to use) was irregular, and/or had a long cycle (35 days), may cause a period of amenorrhea (called post-contraceptive amenorrhea). In fact, hormonal contraceptives put the body in a “pregnancy state” and the return of menstruation can take some time.

– The practice of sports at a professional level or a demanding sport can cause amenorrhea. This is particularly the case among marathon runners, bodybuilders and professional athletes. Fat mass is reduced to the extreme, where there is a decrease in estrogen in these athletes. More restrictive and calorie-poor diets contribute to the occurrence of amenorrhea.

– In addition, rapid weight loss, strict dieting and pathological eating behavior (anorexia, bulimia) often cause the cessation of menstruation.

– Stress or psychological trauma can also be a cause of amenorrhea. Trauma or psychological stress is defined as divorce, death of a loved one, moving, traveling, job loss, interruption in lifestyle. All this can influence the functioning of the hypothalamus and cause the cessation of menstruation. As long as stress persists, amenorrhea will also persist.

– Obesity , the use of certain medications (oral steroids, antidepressants, antipsychotics, anticancer drugs), uterine scarring are other causes of amenorrhea.

In less frequent cases can be listed: anomalies of the development of Organs sexual organs, an anatomical anomaly of the sexual organs (main causes of primary amenorrhea), chronic endocrine diseases (see also hyperthyroidism, hypothyroidism, diabetes), or surgical ablation of the uterus and/or of the ovaries.

– An ovarian cyst can also lead to amenorrhea.

Symptoms

The only symptom of amenorrhea is a lack of menstruation. Other symptoms are related to the possible causes that lead to amenorrhea (eg hot flashes and mood swings in the case of menopause).

Treatments

In most cases, the causes of amenorrhea are benign and curable. Just have a healthy lifestyle (see below for good advice). In this case, medical treatment is not necessary.

Hormone treatment in case of amenorrhea due to:

– A dysfunction of the ovaries: hormone treatment will be prescribed to favor the development of secondary hormonal characteristics and to prevent osteoporosis.

– Menopause: combined hormone replacement therapy (estrogens + progesterone) is recommended for women entering menopause. Menstruation is maintained, but ovulation remains absent. The benefits of this therapy in relation to breast cancer are currently very controversial. Prescription is generally only given to women with unpleasant menopausal symptoms (hot flashes, mood swings) for a long time.

– Removal of ovaries and uterus (before the presumed age of menopause): combined hormone therapy (estrogen + progesterone) is prescribed, in particular for the prevention of osteoporosis.

Non-hormonal treatment of amenorrhea

– In cases of amenorrhea due to an overproduction of prolactin (result of a pituitary tumor, for example), the doctor will prescribe Bromocriptine (Parlodel®). This drug is also prescribed as a dopamine agonist in Parkinson’s disease.

– Surgery is sometimes performed when there are malformations of the reproductive system, but it does not necessarily lead to a return of menstruation (especially in the case of major malformations).

– Psychotherapy is highly recommended if the amenorrhea is caused by trauma or pathological eating behavior (anorexia or bulimia).

Herbal medicine

Heads up! These are complementary approaches. Amenorrhea can hide other problems. It is important to consult a doctor in case of prolonged amenorrhea.

– Agnocasto : this plant is known for its effect on the irregular menstrual cycle (after treatment for several weeks). It is especially recommended against dysmenorrhea, overproduction of prolactin (which as we saw above can cause amenorrhea), endometriosis, menopausal symptoms.

– European Angelica (Angelica archangelica) is traditionally used to trigger menstruation that is slow. The presence of phytoestrogens is the cause. However, its effects compared to natural hormones are minor. Angelica is used in traditional Asian Chinese medicine for women’s cycle disorders, and menopause.

Tips & Prevention

The best treatment is always prevention!

– It is important to have a healthy and balanced diet to keep “fit”. A certain amount of “fat” is needed to store, and partly to produce, estrogen. What is your BMI (body mass index)?

It is also important to learn to manage stress. Prolonged stress is synonymous with physiological disorders that can affect your entire body. See our articles on it under stress and anxiety.

– Try to practice regular but moderate physical activity;

– Avoid alcohol and drug abuse, and try to stop smoking if you are a smoker.

See also: painful menstruation – menstrual cramps ( dysmenorrhea )

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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