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Absence of Mensturation

Having no menstrual periods is called amenorrhea or absence of menstruation

Amenorrhea is normal in the following circumstances:

  • Before puberty

  • During pregnancy

  • While breastfeeding

  • After menopause

Amenorrhea is the non-occurrence of the menstrual cycle. It can occur when a girl didn’t get her first menstrual period till the age of 16 years. It also occurs when a woman fails to menstruate for 3 to 6 months.

Amenorrhea can happen for many reasons. The most common causes include pregnancy, other various lifestyle factors including body weight and exercise levels. In some cases, hormonal imbalances or reproductive organs disorder may be the cause for amenorrhea.

Types of amenorrhea

There are two types of amenorrhea as primary and secondary

Primary amenorrhea–Commonly most girls begin menstruating between ages 9 and 18, but 12 is the average age. If a girl hasn’t had her menstrual bleeding, even she passes the age of 16 years.

In this case, Menstrual periods never start.

If menstrual period never starts, girl will not go through puberty thus can cause developing of other sexual characteristics such as breasts and pubic hair that normally not occur in girls.

Secondary amenorrhea– It is when a woman has stopped menstruating for at least three months. This is the more common form of amenorrhea.

In this case, periods start and then stop.

If women have been getting her menstrual periods regularly and then stopped, can occur secondary amenorrhea. It is much more common in women compared to the primary.

Post-pill amenorrhea

After discontinuing oral contraceptive pills a woman should have return of her menstrual within three months after she stopped taking pills. Previously, it was believed that birth control pills increase a woman’s risk of amenorrhea following use of the pill, but this has been proven not to be the case. Women who are not experiencing her menstrual period even after three months when she stops taking contractive pills, she will need a medical check-up because of the chances for occurring secondary amenorrhea.

Causes of absent menstruation

Hormonal disorders, genetic disorders, birth defects and drugs can affect some of your body parts like Pituitary gland, cervix, uterus, hypothalamus and vagina. These disorders can cause amenorrhea, these are the most common cause and depends on the amenorrhea type whether it is primary or secondary.

Primary amenorrhea

The disorder can cause amenorrhea are exceptional, but the most common are listed here

  • Genetic disorder

  • A defect in reproductive organ that blocks the menstrual flow Genetic disorders include

  • Turner syndrome

  • Kallmann syndrome

  • Congenital adrenal hyperplasia- Overproduction of male hormones by the adrenal glands

  • Pseudo hermaphroditism or true hermaphroditism- Genital disorders that result in ambiguous (neither male nor female) genitals

  • Disorders that develops Y chromosome in female (which normally occurs only in males).

Genetic disorders and birth defects that are responsible for primary amenorrhea may not be seen until puberty. These disorders are mainly responsible for primary amenorrhea, not secondary. Sometimes delay in puberty can be observed in girls who do not have a disorder, and normal periods simply begin at a later age. Puberty delay may run in families.

Secondary amenorrhea

The most common causes are

  • Pregnancy

  • Breastfeeding

  • Hypothalamus Malfunction

  • Polycystic ovary syndrome

  • Premature menopause (primary ovarian insufficiency)

  • Pituitary gland or the thyroid gland Malfunctioning

  • Use of certain drugs, like birth control pills (oral contraceptives), antidepressants, or antipsychotic drugs

Women of childbearing age are more likely to have amenorrhea, pregnancy is the most common cause.

The hypothalamus may malfunction for several reasons:

  • When you have too much Stress

  • excessive exercise (usually in competitive athletes, particularly women who participate in sports that involve maintaining a low body weight)

  • it may occur in women who have a Poor nutrition eating habit or who have lost a significant amount of weight

  • depression or obsessive-compulsive disorder or simple we can say mental disorder

  • Radiation therapy or an injury

The pituitary gland may malfunction because

  • Maybe it is damaged

  • A pituitary tumour can cause high Levels of prolactin

An underactive called as hypothyroidism or overactive called as hyperthyroidism thyroid gland may also cause amenorrhea.

Antidepressants, oral contraceptives (sometimes), antipsychotic drugs or certain other drugs may lead an increase in prolactin levels and thus can cause pituitary tumors and some other disorders.

Chronic disorders particularly of the lungs, digestive tract, kidneys, blood, or liver, radiation therapy, some autoimmune disorders, cancer, head injuries, HIV infection, Cushing syndrome, a hydatidiform mole that is overgrowth of tissue from the placenta, and malfunction of the adrenal glands are less common cause of amenorrhea. Fragile X syndrome is a kind of genetic disorder, may cause menstrual periods to stop early. Scarring of the uterus usually due to an infection or surgery, polyps, and fibroids can also the causes for occurring of secondary amenorrhea.

Warning signs

  • Any type of delay in puberty

  • Masculine characteristics changes, such as excess body hair, a deepened voice, and increased muscle size

  • Vision problems(lost or low vision)

  • An impaired sense of smell

  • A milky nipple discharge

  • Weight change

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