Definition

The common duration of a woman's menstrual cycle is within the range of 28–30 days. Amenorrhoea is the absence of menstrual cycles in women of reproductive age, often between 12 and 49 years old. There are two particular types of amenorrhoea, including:

• Primary amenorrhoea refers to the absence of menstruation in a woman who has not experienced it by the age of 16 despite having normal growth and the development of secondary sexual characteristics
• Secondary amenorrhoea refers to the absence of multiple menstrual periods following the onset of menarche

A woman is considered to have amenorrhoea when she has not menstruated for over 6 months. The absence of menstruation due to a person's emotional state is known as psychological amenorrhoea.

Causes

Throughout the menstrual cycle, the hypothalamus and pituitary glands in the brain secrete hormones that affect the ovaries. The ovaries produce estrogen and progesterone hormones, which affect the uterus, leading to menstruation.

The following are associated with the absence of menstruation during a woman's fertile period:

• Anatomical or deformity-related disorders affecting the female reproductive organs
• The physiological process of menstruation
• Endocrine disorders that contribute to menstruation

Amenorrhoea might have multiple causes, but psychogenic amenorrhoea specifically happens due to persistent and intense mental stress. Prolonged stress can lead to dysregulation of the hypothalamus, the cerebral region responsible for modulating reproductive hormones. The following are medical problems that might lead to psychogenic amenorrhoea:

• Eating disorders, such as anorexia nervosa or bulimia nervosa
• Generalised anxiety disorder
• Depression
• Psychological trauma
• Drug addiction

Amenorrhoea may result from complex interactions between social and psychological factors.

If you are interested in knowing more about Nervosa anorexia eating disorders, you can read them here: Anorexia Nervosa - Definition, Cause And Risk Factor.

Risk Factor

Eating Disorders

Amenorrhoea is common in patients with eating disorders such as bulimia or anorexia, which might be due to a lack of body fat or other issues. It can influence hormone function, inhibiting fertilisation in individuals with low body weight (about 10% of normal body weight).

Overweight individuals, particularly those with obesity, are also susceptible to amenorrhoea.

Family Background

Parental transmission may result in the inheritance of chromosomal or genetic disorders. Genetic factors may impact the function of the ovaries, which influence the menstrual cycle. There is a higher risk of amenorrhoea if there is a history of early menopause or amenorrhoea in the patient's family.

Excessive Exercise

This is prevalent among female athletes. Low body fat, high tension levels, and excessive energy consumption contribute to a delayed menstrual cycle.

If you are interested in knowing more about the eating disorders of bulimia Nervosa, read it here: Bulimia Nervosa - Definition, Cause And Risk Factor.

Symptoms

Primary Amenorrhoea

At the age of 13, this condition can be identified by the absence of indicators of puberty or secondary sexual characteristics in females, including the following:

• Mammary gland (breast) development
• Growth in stature and body mass
• Pubic or axillary hair growth
• Additionally, if females have developed secondary sex characteristics but have not yet had their first menstruation by the age of 15

Secondary Amenorrhoea

Women who previously had regular menstrual cycles may have amenorrhoea, defined as the absence of menstruation for three months or more. If an individual's menstrual cycle is irregular, this indicates that they do not experience menstruation for at least six months.

Psychogenic Amenorrhoea

Psychogenic amenorrhoea happens as a result of elevated stress levels or the presence of psychological disorders in the individual. 

Patients could have concerns regarding:

• Problems with mood and feelings
• Sleep disorders
• Anxiety
• Changes in eating habits and body weight

If you want to know more about depression, read it here: Depression - Definition, Cause And Risk Factors.

Diagnosis

The doctor will inquire about your symptoms and your past medical history. At the beginning of the examination, the doctor may consider the patient's age and any signs of puberty to identify the type of amenorrhoea that has occurred, whether it is primary or secondary. A pregnancy test may help the doctor determine other conditions as an additional diagnostic instrument.

The doctor might perform an initial interview for psychological amenorrhoea to analyse the patient's mental state and assess their psychological well-being. The doctor will inquire about the patient's medical history and past conditions. Following that, the doctor may also conduct a comprehensive physical assessment. A pelvic examination can also be performed if necessary.

Additional examinations suggested by doctors include the following:

• Hormone level assessments through blood testing
• Genomic analysis
• Diagnostic imaging procedures such as magnetic resonance imaging (MRI), ultrasound, or computed tomography (CT) scan

Management

Treating the underlying cause of amenorrhoea is the primary goal of treatment.

Psychological factors such as stress, weight fluctuations, or sadness can disrupt the normal functioning of the menstrual cycle, leading to amenorrhoea. The doctor will advise you to have a psychological consultation with a psychologist or psychiatrist to analyse your medical condition. Antidepressants or anxiolytics may be prescribed based on your specific condition.

In cases of eating disorders, amenorrhoea might result from malnutrition. Therefore, the doctor may develop a suitable eating plan for the patient. They may also engage the family members in the counseling process.

The doctor may prescribe hormone replacement therapy to help recover the regular menstrual cycle. Your doctor will further recommend lifestyle modifications to ensure the return of your menstrual cycle.

Complications

Amenorrhoea may lead to several complications, including:

• Infertility

Without a menstrual cycle, it is impossible to become pregnant. An imbalance of hormones has the potential to induce amenorrhoea. This may also result in miscarriage and other complications throughout pregnancy.

• Osteoporosis

Inadequate estrogen levels are common in women who experience irregular menstrual cycles. This disease can significantly increase your susceptibility to bone fractures due to osteoporosis. Doctors will provide vitamin D and calcium supplements.

Prevention

Lifestyle modification is a possible way to prevent psychogenic amenorrhoea. To achieve this, you may:

• Maintain optimal body weight
• Maintain a healthy diet
• Keep track of your period history
• Perform regular checks
• Sleep regularly and adequately

When to See a Doctor?

Consult a medical professional if you are no longer experiencing menstruation. Talk about your condition to receive the appropriate treatment.

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