Health: When mother nature does not show up...

March 11, 2014

Hey Lovelies! 

I hope you all are having a fabulous week so far. Today we are going to talk about a situation that a lot of women are very familiar with. Get your pen and paper ready, because the word of the day is "Amenorrhea". Amenorrhea a medical term used to describe the absence of a menstrual period in a woman of reproductive age. Not having your periods can be a very stressful situation for any woman. Hopefully, by the end of this post, I will help you figure out, what might be the cause in your specific situation. If any of these apply to you, I strongly recommend, that regardless of your understanding on the issue, that you see a doctor.

Amenorrhea is classified into 2 Types; Primary & Secondary Amenorrhea. While there are loads and loads of causes in each category, I will talk about the most common ones

Continue to read...

Primary Amenorrhea
This is the absence of menstruation in a woman by the age of 16. Meaning that she has NEVER had a period. Some Causes include;

1) Uterine/ Mullerian Dysgenesis- This is due to an abnormally formed uterus in-utero (while in your mother's womb). The uterus is a very important organ as that is where babies are carried. In order for you to have your periods, you need a normal functioning uterus.

2) Vaginal Atresia/ Imperforate Hymen: This is due to the abnormal formation of the vaginal wall or vaginal opening. An imperforate hymen means that your vaginal opening is sealed shut i.e. There is no opening. Some women will go through their cycle but because there is no opening, the blood will accumulate in the vaginal wall. A surgical procedure will be needed to open the hymen and drain the accumulated blood.

3) Turner's Syndrome: This is a genetic condition in which a girl does not have the usual pair of  two X chromosomes. Girls with the condition develop as females, however, their female reproductive organs do not fully develop, they never have periods, and as such tend to be infertile.

4) Receptor Abnormalities for the Hormones, Follicle-Stimulating Hormone (FH) and Luteinizing Hormone (LSH): The FSH and LH are very important hormones in ovulation and menstruation. FH and LSH need to bind to their receptors in order to work. Think of it like a lock and key. The FH and LH hormones are like the key, the receptors are like the lock, if the lock is damaged, the key wont fit. In this case, ovulation and menstruation won't occur if FH and LSH can't bind to their receptors.

5) Problems with the Pituitary Gland: The pituitary gland is the organ in the brain that produces reproductive hormones such as FH and LSH, that are needed for Ovulation and menstruation. If there is a problem with the organ, these hormones will not be produced, and so no menstruation will occur.

Secondary Amenorrhea:  
This is the absence of menstruation for 3 months in a woman with regular cyclic bleeding, or 6 months in a woman with irregular periods. Meaning that a woman used to the get her periods, THEN IT STOPPED.

1) Pregnancy: This is most common cause of secondary amenorrhea. If a woman is pregnant then she will not have her periods.

2) Breast Feeding: This works as a contraceptive method too, as a woman who is breastfeeding may not get her periods. This does not work 100% of the time, so if you know you are not planning to have another baby soon, then another form of birth control is recommended.

3) Premature Menopause: This is may be the case in a young woman who stops to see her periods. To confirm that one has undergone premature menopause, Your doctor will have to check your hormones.

4) Low estrogen Levels: Estrogen plays a huge role in fertility. During menopause, the estrogen levels become low, that is why women that are menopausal do not have periods. If you a woman of child bearing age, who happens to have low estrogen levels, this will affect your periods and you may experience secondary amenorrhea. This is often the case, in women who have undergone premature menopause. Some birth control pills or injections can also contribute to low estrogen levels. It may be difficult to tell if your estrogen is low without running tests, but because estrogen helps with libido, a woman with low estrogen levels may experience low libido. When you see a doctor, there are tests that can be done to determine whether or not your estrogen levels are low.

5) Hyper-Prolactinemia: Prolactin is one of the hormones produced in the Pituitary gland in the brain. It mainly functions in lactation and breast development during pregnancy. When a woman has high levels of prolactin, there tends to be galactorrhea (milk discharge from the nipples) There are two main causes of abnormally high prolactin levels. A tumor (Prolactinoma) in the part of the pituitary gland where Prolactin is produced will cause over secretion of this hormone. Another hormone, called Dopamine works to block the effect of Prolactin. This Hormone called Dopamine is sometimes over secreted (this is the case in Psychotic patients). So in order to treat these patients, they have to be given Medications that block Dopamine. If Dopamine is blocked (by antipsychotic medication, for example), then Dopamine cannot work to block the effect of Prolactin, causing very high levels of Prolactin, which cause NO PERIODS, AND MILKY NIPPLE DISCHARGE (galactorrhea). To diagnose this, your doctor will have to check your serum (blood) prolactin levels. To treat, you will be given a Dopamine agonist (medication that works like Dopamine); this will help bring your prolactin levels down.

6) Anorexia,  Extreme Weight Loss and Exercise: Anorexia nervosa is an eating disorder where people lose more weight than considered healthy for their age and height. Due to their extreme fear of weight gain, they exercise excessively, and may not eat, or use inappropriate means to lose weight. Extreme weight loss and exercising may affect your periods. This is sometimes the case in female athletes that play competitive sports.

7) Stress: Extreme stress can be a cause of secondary amenorrhea. Your body may respond to extreme stress by shutting down hormones responsible for your periods. Your periods will resume, one you are able to keep your stressors under control. You can find tips on how to manage your stress, in a previous post Here

8) Thyroid Problems: When your thyroid is over active (hyperthyroidism) or under active (hypothyroidism), this can also affect your periods. Typically, hyperthyroidism manifests as excessive sweating, hand tremors, palpitations, weight loss, diarrhea. If you experience any of these symptoms, in addition to lack of menstruation, it is imperative that you see a doctor, who will check your thyroid function by checking the level of your thyroid hormones. If on the other hand, hypothyroidism manifests as weigh gain, cold intolerance, constipation, and tiredness.

9) Polycystic Ovarian Syndrome (PCOS): This is a condition where multiple cysts grow on the ovaries, causing hormonal imbalance, and ultimately secondary amenorrhea. This can cause hormonal imbalance which affects your periods as well as your body. Some of the symptoms of PCOS include weight gain and trouble losing weight, hirsutism (growth of hair in a male pattern, e.g. on your face and body), Acne, thinning hair on the scalp, irregular periods, depression, and fertility problems. Women with PCOS tend to have problems conceiving. To help with regulating your periods, your doctor can prescribe Birth Control Pills. There are also medications available that will help you conceive. Your Obstretrics and Gynecology doctor or Fertility specialist, will best advice you on what is best for you. To diagnose PCOS, an Ultrasound of your ovaries has to be done, to confirm the cysts in your ovary or ovaries.

10) Drugs and Medical Treatment: Like I previously mentioned, certain medications such as Anti-Psychotics given for mental illness may cause secondary amenorrhea. Anti-psychotics work by blocking Dopamine (which is over produced during psychosis). Dopamine blocks Prolactin, which prevents periods. So if Dopamine is blocked by Anti-psychotic medications, then you produce too much Prolactin, SO NO PERIODS. Also, Chemotherapeutic drugs used to treat cancer, may have side effects that include amenorrhea. Radiation treatment for certain cancers such as Cervical, Ovarian, or Vaginal cancer can also cause Seocndary Amenorrhea.

11) Scar Tissue Formation: Scar tissue can form untreated cervical/pelvic infections, such as Pelvic Inflammatory Diseases (PID) or even tuberculosis. Women may also form scar tissue in the Uterus from multiple Dilation and Curettage (D & C), especially if not properly done. D & C involves dilating the cervix and scraping the linings of the Uterus with a spoon-shaped instrument, called a Curette. When this is done aggressively, by someone who has little or no experience, scar tissue may form in the uterus. Not only may it lead to Amenorrhea, the patient may become infertile. This condition is medically termed as Asherman's Syndrome.

Think any of these apply to you?
I strongly recommend that you speak to a Doctor, particularly one specialized in Obstetrics and Gynecology.

I will be very happy to answer any questions that you may have. Email me at

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