Amenorrhea - Absent or Irregular Periods

Irregular or absence of periods can happen because of many reasons. It can be affected by some underlying condition or your lifestyle. Their signs and symptoms may also differ. There can be multiple symptoms and when you notice one or more symptoms you should consult a doctor.

Signs and Symptoms of Amenorrhea

Absence of period in the main symptom of amenorrhea. However, you might experience other symptoms as well which may vary according to the cause of amenorrhea. If you think you might have this condition look for the symptoms like:

• Milk like nipple discharge
• Hair loss
• Headache
• Vision changes
• Excess facial hair
• Pelvic pain
• Acne

If you have one or more symptoms mentioned above along with the absence of a period then consult your nearest doctor.

Amenorrhea Causes

Amenorrhea can occur for multiple reasons. Some of them are normal during a woman's life, while others may be a side effect of medication or a sign of a medical/ psychological problem. Even lifestyle choices can affect amenorrhea or the absence of periods [1]. Amenorrhea can be caused by multiple reasons. Such as

Natural causes of Amenorrhea are:

• Pregnancy (the most common natural cause)
• During Breast-feeding
• Menopause (End of the menstrual cycle in a woman’s life)

Lifestyle factors can cause Amenorrhea Includes:

• Low body weight: Low body weight is one of the major reasons for primary amenorrhea. Young girls who are very thin or very athletic fail to put on weight during puberty. This puberty related rise of body fat triggers the beginning of the menstruation.
• Excessive exercise: Having a healthy lifestyle is needed but some women who participate in activities that require rigorous training, such as boxing, might find their menstrual cycles interrupted. Multiple factors combine to contribute to the loss of periods in athletes, including very low body fat, stress etc.
• Stress: Mental stress can alter the functioning of the hypothalamus, the area of one's brain that controls the hormones that regulate the menstrual cycle. Ovulation and menstruation may stop as a result of stress [2].

Medications:

There are certain medications that can cause periods to stop, E.g:

• Antipsychotics
• Chemotherapy
• Antidepressants
• Blood pressure medications
• Anti-allergic drugs

Medical conditions that can Amenorrhea:

• Polycystic ovary syndrome (PCOS): PCOS causes high and consistent levels of hormones, which is not seen in the normal menstrual cycle.
• Thyroid malfunction: An overactive thyroid gland (hyperthyroidism) or underactive thyroid gland (hypothyroidism) can cause menstrual irregularities and that includes amenorrhea.
• Pituitary tumor: A benign (non-cancerous) tumor in the pituitary gland can cause unusual hormonal regulation and cause menstrual irregularities.
• Premature menopause: Menopause usually begins around age 50. But, for some women, it can be much earlier. This can permanently stop menstruation.

Amenorrhea caused by issues in Reproductive Organs:

• Uterine scarring: Uterine scarring prevents the normal buildup and shedding of the uterine lining which may cause amenorrhea.
• Absence of sexual organs: Sometimes due to developmental anomalies, a girl can be born without some major parts of her reproductive system, e.g the uterus, cervix or vagina. Because of these undeveloped reproductive organs, a girl can't have menstrual cycles.
• Abnormal structure of vagina: An obstruction in the due to some structural abnormality of the vagina may prevent visible menstrual bleeding. This can cause amenorrhea.

Diagnosis of Amenorrhea

Amenorrhea is not a life-threatening condition, but research has shown that the loss of the menstrual cycle has been associated with a high risk of hip and wrist fractures [3]. Hence, if you have noticed any of the symptoms of amenorrhea it is better to get a proper diagnosis. A doctor performs multiple tests to confirm the condition that includes a pelvic exam to check for any problems with the reproductive organs. If a woman never had a period, the doctor may physically examine the breasts and genitals to see if she is experiencing the normal changes of puberty. Amenorrhea can also be a sign of a complex set of hormonal problems. Finding the underlying cause can take time and may require multiple tests.

Lab tests to Diagnose Amenorrhea: A variety of blood tests are important for the diagnosis-

• Pregnancy test
• Thyroid function test
• Ovary function test to know the amount of follicle-stimulating hormone (FSH)
• Prolactin test to rule out pituitary tumor
• Male hormone test

Imaging Tests to Diagnose Amenorrhea: Depending on your signs and symptoms the doctor might recommend one or more imaging tests like:

• Ultrasound: This is a very common imaging method where sound waves produce images of internal organs. The doctor may suggest an ultrasound test to check for any abnormalities in the reproductive organs.
• Computerized tomography (CT): CT scans combine many X-ray images taken from different directions to create cross-sectional views of internal structures.
• Magnetic resonance imaging (MRI): MRI uses radio waves with a strong magnetic field to produce very detailed images of soft tissues within the body. Your doctor may order an MRI test to check for a pituitary tumor.

Scope Tests to Diagnose Amenorrhea: The doctor may recommend a hysteroscopy where a test in which a thin, lighted camera is passed through the vagina and cervix to look at the inside of your uterus.

Complications of Amenorrhea

Amenorrhea does not cause any life-threatening problems. But, it may lead to the following complications if the condition persists.

• Chronic or prolonged amenorrhea can cause infertility
• It can also cause osteoporosis (weakening of bones)

Amenorrhea means either you haven’t achieved your periods yet or they have stopped for some time. This means your body is not able to produce viable eggs for ovulation which can affect your fertility. Whether it is primary or secondary amenorrhea, stopped or no periods can affect your fertility as it is very likely that you are not ovulating. Ovulation is a process where your ovaries release an egg during periods. This egg, when fertilised by a sperm, causes pregnancy. If you are not having periods you are most likely not ovulating either. Also, if you have primary amenorrhea it means you cannot become pregnant at all as ovulation has not started in your body.

The treatment of amenorrhea will depend on the underlying cause of your condition [4]. In some cases, hormone therapies or contraceptive pills can restart menstrual cycles. Amenorrhea which is caused by thyroid or pituitary disorders may be treated with medications for the specific condition. If a tumor is a present or structural blockage is causing the problem for that surgery might have to be done. Some lifestyle changes can help to treat amenorrhea. Factors such as too much exercise or too little food can cause amenorrhea.

One must be aware of changes in the menstrual cycle and check with the doctor if she has concerns. A woman must keep a record of when cycles occur. Note the date your period starts, how long it lasts and any troublesome symptoms you experience.

Eating too little or not getting the right nutrients for the body may stress hormones, which can affect periods. It is discussed below how home remedies and lifestyle changes can help Amenorrhea.

Say no to high-fiber diets:

Fiber may lower the concentrations of:

• Progesterone
• Estrogen
• luteinizing hormone (LH)
• Follicle-stimulating hormone (FSH)

These hormones also play important roles and as a result, having too much fiber may affect by making periods late. It is recommended to get 25 to 30 grams of fiber per day. Try avoiding foods like whole-wheat bread, high fiber fruit juice, microwave popcorn, cereals, quickly cooked oatmeals, etc.

Include enough fats in your diet:

Consuming enough fats helps to support hormone levels and ovulation. Polyunsaturated fatty acids (PUFAs) helps the most. Common sources of PUFA are:

• Fatty fish like salmon, sardine, mackerel
• Vegetable oils
• Walnuts
• Flax seeds

Food that plays an important role:

Fruits can also help with regulating your periods hence treating amenorrhea. Some of the highly beneficial fruits to eat for treating amenorrhea are:

• Unripe Papaya: Unripe papaya helps contract muscle fibers in the uterus which helps regulate menstruation. You can eat unripe papaya every day for a few months (not during your periods) for treating amenorrhea.
• Cinnamon: Cinnamon can help regulate insulin levels in the body, which may have an effect on the menstrual cycle. You can consume cinnamon in your diet by using it in your curries, soups, drinks, shakes, etc. Cinnamon tea is also a good option, you can take any type of tea and put cinnamon in it. You need to drink the tea daily for several months to reduce amenorrhea. Another way of taking cinnamon would be by making a drink of cinnamon, lemon juice, and water. Put a cinnamon stick and lemon juice in boiling water and drink it when its temperature settles down. Drinking this solution regularly helps with treating amenorrhea.
• Turmeric: Turmeric root contains a phenolic material called curcumin, which has many beneficial health effects, including reducing inflammation and improving mood. Because of these effects, taking supplements containing curcumin can decrease symptoms of amenorrhea. You can include turmeric in your diet by simply using it in your curries and other food or drinks you make. Other ways of including turmeric in your diet are:
• Drink turmeric with coconut milk. Mix two tablespoons of turmeric in coconut milk and drink it twice a day for a few weeks.
• You can also eat raw turmeric directly with honey. Take raw turmeric and peel the skin off. Grate the turmeric and mix it with honey. You can directly eat the paste. Eat this paste daily for a few months for better results.
• Finally, you can opt for a turmeric tea, you can easily find turmeric tea in your market or online. Drink the tea every day on empty stomach for several months for treating amenorrhea
• Aloe Vera: Aloe vera can help regulate your hormones hence treating menstrual irregularities. For best results, extract the aloe vera gel from the leaf and mix it with a tablespoon of honey. Consume it daily before breakfast.
• Ginger: Ginger is also a highly recommended food for regulating irregular periods. For best results, add a small piece of ginger and sugar in boiling water. Drink this mixture 3 times a day after your meals.

Regular exercise:

Getting regular exercise has many benefits, including regulating periods. To reduce symptoms and have a healthy goal, one must aim to get about 30 minutes of exercise per day, such as walking, running, cycling, yoga or swimming, etc.

Amenorrhoea or irregular bleeding may result in fertility issues in women. However, there are many treatments available at this point that can address this issue.