A colleague’s daughter is 18years old. She has stopped attending school. When asked, she said that her classmates tease her because she did not get her periods till now. She became depressed, thinking that there is some abnormality in her body. When they consulted the doctor, he diagnosed it to be primary amenorrhea, probably caused due to obesity. The doctor advised her to lose weight. She gradually lost weight, following which she got her first periods. This could be a situation faced by any girl, it is important to know the causes of and management of amenorrhea.

One of the organs in the female reproductive system is the ovaries that form the ovum or the egg that is needed for reproduction. Every month the process called as ovulation takes place in which the ovarian follicle in the ovary matures and releases the egg for fertilization (union with the sperm). If fertilization does not take place, the egg degenerates itself and you have your monthly periods.

A girl starts menstruating during her puberty when her reproductive organs mature. The start of menstruation is called as menarche. The age of menarche varies from one girl to another and may range from 10 to15 years. If you are not getting your periods, then the condition is called as amenorrhea.

Amenorrhea can be primary or secondary.

Primary amenorrhea refers to the condition where the female has not started menstruating even at the age of 16 years and above.

In secondary amenorrhea, the woman may have started menstruating but the periods are irregular, like they occur once in 3 to 4 months.

Amenorrhea is a symptom and not a disease. To treat amenorrhea effectively, the doctor has to go to the root of the underlying cause.

Primary amenorrhea can occur due to the following reasons;

  • Abnormal chromosomes
  • Problem with hypothalamus (area in brain that regulates menstrual cycle)
  • Diseases of the pituitary gland (gland present under brain that regulates menstrual cycle)
  • Obstruction of vagina due to a membrane that blocks menstrual flow

Secondary amenorrhea can occur due to the following reasons;

  • Use of birth control pills, stress
  • Pregnancy
  • Breastfeeding
  • Low body weight
  • Heavy exercise
  • Use of medications like antipsychotics, chemotherapy medicines and antidepressants

It is important to know the underlying cause for amenorrhea which requires certain tests conducted by the doctor.

The first test the doctor conducts is pregnancy test to check if the reason for amenorrhea is pregnancy.

The doctor does a complete physical examination and enquires about your past medical history.

Examination of pelvis is done to check the reproductive organs for any problem.

To check for any hormonal problems, blood tests like evaluation of prolactin level and thyroid function tests are done.

If the woman has increased hair growth, the level of male hormone is checked.

To know if your menstrual cycle has stopped due to lack of estrogen, a progestin challenge test is done in which the doctor prescribes progestogen hormone for 7 to 10 days due to which menstrual bleeding occurs.

Results of the test confirm whether amenorrhea is due to lack of estrogen.

To check for any abnormalities in the reproductive organs and to detect pituitary tumors imaging tests like magnetic resonance imaging, Computerized Tomography and Ultrasound are conducted.

Hysteroscopy or Laparoscopy may be conducted which is a minimal invasive surgery that is done to check the internal organs for any abnormalities.

The treatment of amenorrhea depends on the underlying problem that is causing it. Depending on your stress level, physical activity and weight, lifestyle changes have to be made. If the reason for amenorrhea is pituitary or thyroid disorder, then it is treated with medications, whereas if it is hypothalamic amenorrhea, then it is treated by prescribing oral contraceptives.

It is important for you to eat healthy and exercise regularly.

Stress in life also affects your health adversely. To decrease stress, connect with your family and friends and allot some time for recreation daily.

If your periods are irregular, note down the dates in your diary and give the information to your doctor.

You can use the home pregnancy test to check if you are pregnant. Remember that even if your periods are irregular there is a possibility of you getting pregnant.

Consulting your doctor at the earliest is the best way for effective treatment.