Amenorrhoea – Absence of Periods

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Amenorrhoea is a condition in women. It refers to the absence of menstruation.

AmenorrhoeaWhat is amenorrhoea?

Menstruation is a woman’s monthly period, the medical term for absence of periods in a woman is Amenorrhoea.

During the course of a woman’s life -- the periods of amenorrhoea are -- before puberty, pregnancy and breastfeeding and menopause. Amenorrhoea could be due to problems in the central nervous system (brain and spinal cord), glands, organs like the ovaries or hormones involved in the female reproductive system.

Classification of amenorrhoea:

Primary amenorrhoea: If a woman has never got menses till she is 16 years, it is called primary amenorrhoea. Normally when a woman reaches puberty, menses start within two years of it and is called ‘menarche’ in medical terms.

Secondary amenorrhoea: If periods suddenly cease for three months after having regular menstruation, it is called secondary amenorrhoea.

Causes for amenorrhoea

Primary amenorrhoea:

  • Congenital anomalies of the reproductive organs, e.g. absence of uterus.
  • If ovaries fail to release eggs.
  • Problems in the central nervous system or pituitary gland, responsible for producing female hormones.
  • Cryptomenorrhoea: In this rare condition a thick membrane in the vagina causes the menstrual blood to be trapped inside. Hence there is no visible periods, causing amenorrhoea.
  • Unknown: In many instances the exact cause of amenorrhea is unknown.

 Secondary amenorrhoea

  • Physiological reasons like breastfeeding or menopause
  • Family history of amenorrhoea may be a risk factor, as you may be genetically predisposed to this condition.
  • Oral contraceptives (OC pills) are often implicated in amenorrhoea. Stopping the medication will enable periods to resume after three to six months from the date of stopping.
  • Drugs: Anti-depressants, anti-psychotics, anti-cancer drugs and drugs used to control blood pressure sometimes cause amenorrhoea.
  • Obesity: excessive weight gain causes hormonal imbalance and amenorrhoea may be a symptom.
  • Over exercising or eating disorders like bulimia or anorexia nervosa can causes undue stress on the body causing amenorrhoea.
  • Thyroid gland disorders: Hyperthyroidism and hypothyroidism both are culprits.
  • Stressful life: mental and physical stress can lead to changes in the part of the brain called hypothalamus and amenorrhoea can be a manifestation of it.
  • Polycystic ovarian syndrome (PCOS): PCOS leads to hormonal imbalance causing amenorrhoea.
  • Scar formation in the inner lining of the uterus: This is called Asherman’s syndrome and it commonly occurs after the procedure Dilatation and Curettage (D & C). It is known to cause amenorrhoea.
  • Surgery: Hysterectomy or removal of the uterus causes cessation of periods and as a result the woman has premature menopause.
  • Tumours: A tumour in the pituitary gland can lead to a hormonal imbalance and consequently amenorrhoea.
  • Poor nutrition and psychiatric causes like depression are also responsible for causing amenorrhoea.

Signs and Symptoms of amenorrhoea:

Amenorrhoea is generally a symptom of an underlying disorder. Along with absence of menses the other signs and symptoms are:

  • Excess facial hair
  • Nipple discharge
  • Hair loss
  • Vision impairment
  • Headache

Written by Dr Nisreen Nakhoda, General Physician

Find out how to diagnose and treat amenorrhoea 

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