The absence of menstruation (amenorrhea) can be a sign of happiness (pregnancy) on the one hand, on the other – a cause for concern if you are not aware of the cause. Amenorrhea is not always due to something scary. In the lines below you will pay attention to possible reasons other than pregnancy to stop the cycle.
What is amenorrhea (lack of cycle)?
The normal duration of the monthly cycle is between 21 and 35 days, most ladies menstruate on the 28th day. For some women, their cycle is like a clock – on any date each month, while for others it can vary by several days. Both conditions are completely normal.
By amenorrhea is understood the absence of menstruation. It is primary and secondary. [1]
Difference Between Primary and Secondary Amenorrhea
Primary amenorrhea refers to the absence of menstruation in a girl who has not had a period until the age of 15. The most common causes of primary amenorrhea are associated with a violation in hormone levels, although anatomical problems can also be the cause of amenorrhea. [1]
Secondary amenorrhea refers to the absence of three or more consecutive menstruations in a girl who has already menstruated. Pregnancy is the most common cause of secondary amenorrhea, although there are many other causes of secondary amenorrhea. [1]
Main causes of sudden cessation of the cycle (secondary amenorrhea)
The lack of a cycle can be due to many reasons. Some of them are completely natural, others may be due to a medical problem.
Natural amenorrhea
The most natural reasons for abruptly stopping the cycle are:
- Pregnancy;
- Lactation;
- Menopause;
- Contraceptives – Some people who take birth control pills (oral contraceptives) may not have a cycle. Even after stopping contraceptives, it may take some time before regular ovulation and menstruation resume. Contraceptives that are injected or implanted can also cause amenorrhea, as can some types of intrauterine contraceptives. [1,2]
Medication
Some medications can cause the cycle to stop suddenly. These include: antipsychotics, chemotherapy, antidepressants, some blood medications, some antihistamines. [1]
Lifestyle factors that can lead to a lack of cycle:
- Low weight – Too low body weight interrupts many hormonal functions in the body, potentially stopping ovulation. Women who have an eating disorder such as anorexia or bulimia often have problems with their monthly cycles due to these abnormal hormonal changes.
- Too heavy training. Women who exercise too much may have a menstrual cycle stop. The reasons are low body fat, stress and high energy expenditure.
- Stress – Mental stress can temporarily alter the functioning of the hypothalamus – an area of the brain that controls hormones that regulate the menstrual cycle. As a result, ovulation and menstruation can stop. Regular menstrual periods usually resume after stress decreases. [1]
- Contraceptives – You may not have a completely regular cycle if you are taking birth control pills. This is usually not a cause for concern. Some types of contraception, such as progestogen-only pills (POP), contraceptive injection, and intrauterine IUS, can cause the cycle to stop completely. [2]
Chormonal imbalance:
- Polycystic syndrome (PCOS) – Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects 6-8% of women worldwide. Symptoms include: irregular cycle, increased hair, difficulty getting pregnant, increased weight, acne. PCOS can also lead to hyperandrogenesis when a woman has high levels of male hormones. Hyperandrogenesis often leads to amenorrhea. [3]
- An overactive thyroid gland (hyperthyroidism) or insufficient thyroid function (hypothyroidism) can cause menstrual problems, including amenorrhea. [1]
- A benign tumor of the pituitary gland can interfere with the hormonal regulation of menstruation. [1]
- Premature menopause. Menopause usually begins around the age of 50. In some women, the supply of eggs in the ovaries decreases before the age of 40 and menstruation stops. [1]
Structural problems
Problems with the genitals can also cause problems with the cycle. These include:
- Asherman’s syndrome – is a condition that occurs after curettage, dilation / method of abortion / and curettage, cesarean section or treatment of uterine fibroids. Intrauterine adhesions occur, which do not allow normal thickening and separation of the uterine mucosa. [4]
- Lack of reproductive organs. Sometimes problems arise during the development of the fetus already intrauterine, which lead to missing parts or organs of the reproductive system. There may be a lack of the uterus, cervix or vagina. Since the reproductive system has not fully developed, menstrual cycles are not possible later in life. [1]
- Structural abnormality of the vagina. Blockage of the vagina can disrupt visible menstrual bleeding. In the vagina there may be a membrane or wall that blocks the outflow of blood from the uterus and cervix. [1]
How is it diagnosed?
During the examination, the doctor will perform a pelvic examination to check for problems with your reproductive organs. If you’ve never had a period, your doctor may examine your breasts and genitals to see if the characteristic changes for puberty have begun. Amenorrhea can be a sign of a complex set of hormonal problems. Discovering the underlying cause can take time and may require more than one type of testing.
What tests are appointed?
Various blood tests may be necessary, including:
- Pregnancy test. This will likely be the first test your doctor suggests to rule out or confirm a possible pregnancy. [1]
- Measuring the amount of thyroid stimulating hormone (TSH) in your blood can determine if your thyroid is working properly. [1]
- Measuring the amount of follicle-stimulating hormone (FSH) in your blood can determine if your ovaries are working properly. [1]
- Test for prolactin. Low levels of the hormone prolactin can be a sign of a tumor of the pituitary gland. High levels of the hormone can also lead to a violation in the cycle. [1]
- If you have enlarged facial hair and a low voice, your doctor may want to check the level of male hormones in your blood. [1]
Imaging studies:
Very often, in addition to blood tests, imaging tests are also appointed. These include:
- Ultrasound. This test uses sound waves to create images of internal organs. If you’ve never had a period, it’s a good idea to do this test to check for any abnormalities in your reproductive organs. [1]
- Magnetic resonance imaging (MRI). MRI uses radio waves with a strong magnetic field to create extremely detailed images of soft tissues in the body. Your doctor may order an MRI to check if there is a pituitary tumor, for example. [1]
What is the treatment?
Treatment depends on the underlying cause of your amenorrhea. In some cases, birth control pills or other hormone therapies can resume your menstrual cycle. Amenorrhea caused by thyroid or pituitary disorders can be treated with medication. If the problem is caused by a tumor or structural blockage, surgery may be necessary.
Any interruption of the normal cycle can be very stressful. Don’t be in a hurry to panic. Very often the cause is not serious and is amenable to treatment. When something is bothering you, contact your doctor because he can most accurately determine what is wrong with you and how it can be cured.
[1] https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299
[2] https://www.nhs.uk/conditions/stopped-or-missed-periods/
