Amenorrhea

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

More posts by Christiane Fux All content is checked by medical journalists.

Amenorrhea (missed periods) is natural during pregnancy, breastfeeding, and after the menopause. In other life situations, hormonal disorders, organic complications, an eating disorder such as anorexia and emotional stress can be the reason if the menstrual period does not occur. Read everything you need to know about the causes, consequences and treatment of amenorrhea here.

Brief overview

What is amenorrhea? The absence of a woman's menstrual period.
Causes: natural causes include pregnancy, lactation, and menopause; Pathological causes are e.g. stress, (too) low body weight,
Treatment: depending on the cause of the disease-related amenorrhea, e.g. B. Stress reduction, relaxation techniques, hormone administration, training reduction, weight gain, surgery for tumors
Consequences: inability to get pregnant; psychological problems (feelings of inferiority, not feeling "like a woman")

Amenorrhea: definition

Amenorrhea describes the absence of menstruation (menstruation). This is quite natural during pregnancy and breastfeeding. Girls do not have periods before puberty either. And with the menopause, egg maturation is exhausted, which also gradually subsides the menstrual cycle - until the period stops completely.

In addition to these natural causes of amenorrhea, missed periods can be the result of an illness or (hormonal) disorder. In the case of this pathological amenorrhea, doctors differentiate between two forms:

Primary amenorrhea: This occurs in women who have never had a menstrual period up to the age of 16.
Secondary amenorrhea: This is when the menstrual period has been absent for more than three months, but the affected women previously had a normal cycle.

Amenorrhea: causes and possible diseases

A woman's menstrual cycle is kept going by the interaction of various hormones (such as GnRH, FSH, LH, estrogens), which two brain regions in particular are involved in controlling - the hypothalamus and the pituitary gland (pituitary gland). Amenorrhea is very often caused by a disturbance in this complex hormonal system.

In addition, organic disorders such as organ malformations can also be responsible for the absence of menstrual bleeding.

The most important causes of primary and secondary amenorrhea are presented in more detail below (natural triggers of amenorrhea such as pregnancy or menopause are not discussed).

Primary amenorrhea

Young girls usually have their first menstrual bleeding between the ages of 11 and 13. If this does not occur by the age of 16, doctors speak of primary amenorrhea. The reasons for this are usually innate.

For example, certain chromosomal disorders can prevent the ovaries from responding to hormonal signals from the brain or prevent the genital organs from developing properly. This is the case, for example, with Turner syndrome, Klinefelter syndrome or androgen receptor defects. The system-related lack of functional egg cells (gonadal dysgenesis as in Turner syndrome or Swyer syndrome) and malformations in the genital area are possible causes of primary amenorrhea. The same applies to intersexuality (here the genetically determined gender and the developed sexual organs do not match).

Occasionally, serious illnesses such as cancer and its therapy, disorders of the thyroid or adrenal cortex, autoimmune diseases such as type 1 diabetes or rheumatoid arthritis in childhood are the cause of primary amenorrhea.

Secondary amenorrhea

Important reasons for secondary amenorrhea are, for example:

Stress: An important trigger for amenorrhea are, for example, emotional tension, severe crises, time pressure, traveling and important decisions that are to be made. Exactly how the soul influences hormone production is not yet fully understood. However, stress has a direct effect on the hypothalamus and can thus lower the GnRH concentration, which disrupts the cycle. Mental stress can trigger amenorrhea, especially in women who already have a rather irregular cycle.
Competitive sports: Excessive training also means stress for body and soul and lowers the GnRH level.
Severe weight loss or low body weight: If the woman's body fat percentage falls below a critical value, the organism no longer produces enough hormones to trigger ovulation. Because if the weight is too low, pregnancy would be dangerous for mother and child. That's why the body doesn't even let it happen - it suspends the period. Especially in connection with anorexia nervosa and bulimia, (too) low weight can bring the cycle to a standstill.
Severe mental and physical illnesses: They are also strong stressors that, among other things, can reduce GnRH production.
Incorrectly nested egg: If a fertilized egg nests outside the uterus (extrauterine pregnancy), the hormonal effects on the body are similar to those of a normal pregnancy - the menstrual period remains.
Polycystic ovarian syndrome (PCO syndrome): Here, the production of hormones in the ovaries and in other hormone-producing tissues is disturbed. Among other things, numerous fluid-filled vesicles (cysts) develop on the ovaries. Ovulation often does not occur, and so does the menstrual period.
Thyroid diseases: They too disrupt the hormonal balance. Both overactive and underactive thyroid can prevent menstrual bleeding.
Increased prolactin production: The hormone prolactin inhibits the cycle during pregnancy and breastfeeding and stimulates the production of milk in the breast. In Chiari-Frommel syndrome, prolactin production remains high even after breastfeeding - the milk flow persists for months to years, and amenorrhea occurs. In addition, certain drugs and tumors can also stimulate prolactin production.
Premature menopause: In some women, the ovaries stop functioning before their 40th birthday. Doctors then speak of premature menopause.
Inflammation of the brain: If they occur in the area of the pituitary gland or the hypothalamus, they can disrupt their function - the period does not occur.
Tumors: Both benign and malignant tumors can prevent menstruation. These include tumors on the ovaries, but also in the brain (especially in the area of the hypothalamus and pituitary gland).
Ovarian disorder: e.g. B. due to cysts, surgery, tumors or radiation. Even if the ovaries do not respond to hormonal control by the brain, this can prevent menstruation.
Damage to the uterine lining: Surgery (e.g. scraping) or inflammation can damage the uterine lining to such an extent that it can no longer be built up sufficiently. Then the menstrual period stops.
Chronic kidney failure: Chronic kidney failure has significant effects on the entire organism. Among other things, it can impair the functioning of the genital organs.
Adrenal disorders: Such disorders can be accompanied by an overproduction of the stress hormone cortisol (Cushing's syndrome). This disrupts the cycle up to and including the absence of menstruation.
Medication: Hormone preparations, cancer drugs, psychotropic drugs, cortisone and antihypertensive drugs can disrupt the menstrual cycle.
Withdrawal from hormonal contraceptives: Menstruation may be temporarily absent, especially after the three-month injection. This happens less often after stopping the “pill” (post-pill amenorrhea).
Deliveries with severe blood loss: They can be caused, for example, by a certain functional weakness of the pituitary gland, the so-called Sheehan's syndrome. Affected women do not have a menstrual period for an unusually long time after giving birth (and breastfeeding).

Amenorrhea Treatment: What Does the Doctor Do?

Treatment for amenorrhea depends on the underlying cause of the symptom. For example, hormonal disorders can in many cases be regulated by giving hormone preparations. If the amenorrhea is caused by tumors or malformations of the genital organs, surgery is often the only solution. If the amenorrhea occurs as a result of psychological stress or disorder, psychotherapy can be the method of choice.

In order to initiate the correct treatment, the doctor must first determine the exact cause of the amenorrhea.

diagnosis

The first important step in the clarification of amenorrhea is taking the medical history (anamnesis). In conversation with the patient, the doctor collects important information, for example when the last menstrual period was or whether the woman has ever had a cycle. He may also ask whether there is a possibility of pregnancy and whether there are any other symptoms besides the amenorrhea.

The anamnesis discussion is followed by a gynecological examination, which also includes a vaginal swab and an ultrasound examination of the abdominal organs.

Hormone measurements can also provide important clues about the causes of amenorrhea. Prolactin, progesterone, estrogens, the male sex hormones (androgens) and the hormones FSH and LH produced by the pituitary gland are determined. If a disordered thyroid function is suspected as the cause of amenorrhea, the doctor takes a close look at the blood levels of the thyroid values (TSH, T3, T4).

There are also certain function tests. A few examples: For the so-called gestagen test, the patient takes a progestogen preparation for a few days. If bleeding occurs after weaning, this shows that the uterine lining was actually sufficiently developed - that is, sufficient amounts of estrogen had been produced beforehand because this stimulates the build-up of the uterine lining. The amenorrhea must then have other causes.

If the test is negative, an estrogen-progestin test can be considered. This can be used to check whether the lining of the uterus can be sufficiently activated at all. The doctor first gives the patient oestrogens, which stimulate the build-up of the uterine lining, and then gives progestin. If subsequent bleeding occurs, this indicates that the lining of the uterus is intact.

Depending on the suspected cause of the amenorrhea, further tests may be necessary. These include, for example, imaging procedures - for example if a tumor in the brain is suspected - or a laparoscopy to assess the condition of the ovaries.

Amenorrhea Treatment: What You Can Do By Yourself

Amenorrhea is often psychological. In this case, anything can help that strengthens your psyche and brings it back into balance. This includes relaxation techniques such as autogenic training, progressive muscle relaxation or meditation. But exercise is also a good method to reduce stress and regain your inner balance.Because the body increasingly produces those hormones that reduce or neutralize the stress hormones (e.g. serotonin, endorphins).

If, on the other hand, too intensive sports training is behind the amenorrhea, you should take it easy. If you do not have a menstrual period because you are too thin or you are on an extreme diet, you should try to gain weight again - adipose tissue plays an important role in the production of estrogen. If your amenorrhea is the result of an eating disorder such as anorexia, you should definitely seek professional help. Anorexia is a life-threatening condition that can only be overcome with psychotherapeutic help.

Amenorrhea: consequences

If there is no menstrual bleeding, this can have various consequences for the affected woman.

no pregnancy: without an intact menstrual cycle, a woman cannot become pregnant. So if the menstrual period stops longer, the desire to have children remains underfilled.
Problems in the partnership: If you miss your period, women may feel less feminine. Even the frustration of not getting pregnant due to amenorrhea can cause a long-term stressful relationship to break it in the worst case.

Amenorrhea can indirectly have another consequence: If the absence of the menstrual period is due to a lack of estrogen, this can over time make the bones more fragile - osteoporosis threatens.

Amenorrhea: when do you need to see a doctor?

If you miss your period, a visit to the doctor (gynecologist) is advisable. This is especially true when

You may be pregnant.
You have missed three periods in a row.
You have not had your first menstrual bleeding even after your 16th birthday.
Your period does not stop after you start taking a new medication.
You have stopped bleeding after you stopped taking the pill or other hormonal contraceptives.
You have stopped menstruating after an operation.
In addition to the absence of the norm, you notice other symptoms such as abdominal pain, pain during sex, chest pain or milky discharge from the breasts.
In addition to amenorrhea, you also notice signs of masculinization (virilization) such as hair loss, deeper voice, stronger and more masculine body hair (such as beard and chest hair).

Tags: skin tcm menopause