Amenorrhea is the absence menstrual periods. This is an indication of an underlying medical condition and the accompanying symptoms vary according to their causes.

Treatment of the medical condition causing amenorrhea usually solves this symptom. It should always be accompanied by healthy lifestyle tips, which in some cases may help restore menstrual periods and, depending on the causes, the patient’s fertility.

What is amenorrhea?

Amenorrhea is the absence of menstrual periods and is classified as:

Primary amenorrhea: when a woman over 16 has not had her first period.

Secondary amenorrhea: this is the most common type of amenorrhea. It refers to the absence of a woman’s menstrual period for at least three months when she used to have regular menstrual cycles. The most common cause of secondary amenorrhea is pregnancy, followed by polycystic ovarian syndrome.

Amenorrhea is a symptom of an underlying medical condition which affects 2 to 5 percent of women in the United States. It is normal, however, that menopausal age, younger than 16 and pregnant women do not menstruate.

Amenorrhea main symptoms

Amenorrhea is not a disease but a sign of an underlying medical condition. Therefore symptoms may vary according to the cause.

These may include:

  • Delayed onset of secondary sexual characteristics (pubic hair, breast enlargement)
  • chronic pelvic pain
  • Painful intercourse
  • Hot flashes
  • Decreased libido
  • Irritability and frequent mood swings
  • Galactorrhea or breastmilk production unrelated to breastfeeding
  • Headaches or migraine
  • Visual disorders
  • Weight gain or loss
  • Face, hands and/or feet swelling
  • Decreased or increased heart rate
  • Depression
  • Concentration difficulty
  • Nervousness and anxiety
  • Trembling hands
  • Hirsutism or unwanted hair growth
  • Acne
  • Skin spots
  • Dry skin and brittle nails
  • Infertility

If you have any of these symptoms it is important to schedule an appointment with a fertility specialist as soon as possible to avoid complications.

Amenorrhea causes

Primary amenorrhea may be produced in the hypothalamus, pituitary or ovaries and is usually due to hormonal imbalances. Similarly, it may be caused by abnormal development of the female reproductive system or the presence of an unperforated hymen which obstructs menstrual blood discharge.

Meanwhile, secondary amenorrhea frequently occurs in patients who have undergone one or more uterine curettage, as well as due to hormonal changes (the most common being polycystic ovarian syndrome) and oral contraceptives or intrauterine devices (IUDs) use.

Secondary amenorrhea may also be caused by stress, anxiety, depression, eating disorders, excessive physical activity, weight gain or loss, use of psychotropic drugs and cancer treatments such as chemotherapy and radiotherapy.

Some of the main conditions that can cause amenorrhea are:

  • Pelvic adhesions
  • Anovulation
  • Premature ovarian failure
  • Hyperprolactinemia
  • Thyroid disorders
  • Uterine malformations
  • Uterine fibroids
  • Obesity
  • Insulin resistance
  • Polycystic ovarian syndrome
  • Uterine synechiae

How are the causes of amenorrhea diagnosed?

In addition to a pelvic examination and a patient’s medical history analysis, amenorrhea cause diagnostic procedures may include:

  • A blood test to determine the level of ovarian hormones (estrogen and progesterone), pituitary hormones (luteinizing hormone, follicle stimulating hormone, stimulating thyroid hormone and prolactin) and hypothalamic hormones (gonadotropin releasing hormone). This is done to rule out conditions such as anovulation, premature ovarian failure, hyperprolactinemia, thyroid disorders and polycystic ovarian syndrome
  • A gynecological transvaginal ultrasound (or pelvic vaginal ultrasound) during which the doctor inserts an ultrasound probe into the patient’s vagina in to examine her reproductive organs. This is a non-invasive method to discard malformations, fibroids and  uterine synechiae, which could obstruct menstrual blood discharge
  • An MRI or CT scan if the existence of a pituitary tumor or adenoma is suspected

Treatments to achieve pregnancy in patients suffering from amenorrhea

Once amenorrhea causes are determined, possible treatment options include:

  • Medication use to restore hormonal balance and correct conditions such as insulin resistance in patients with polycystic ovarian syndrome
  • Ovulation induction with medications such as clomiphene citrate and gonadotrophins, which administration must be carefully monitored by a specialist. This fertility treatment is particularly useful in women under 35 which have no other infertility causing factors.
  • If these medications are not enough and there are other causes affecting fertility, the best option is In-Vitro Fertilization (IVF), which allows us to select the patient’s best quality eggs and fertilize them to create embryos which are then transferred back into the patient’s uterus.
  • If the patient does not have any viable eggs, an In-Vitro Fertilization (IVF) and Egg donation (which offer success rates of up to 60 percent), would be the alternative.
  • In very specific cases surgical treatments are necessary to remove pituitary tumors, normalize ovarian hormonal environment or remove barriers which could obstruct menstrual blood discharge

Treatment of the medical condition causing amenorrhea usually solves this symptom. It should always be accompanied by healthy lifestyle tips, which in some cases may help restore menstrual periods and, depending on the causes, the patient`s fertility.