Amenorrhea Explained

 

Brookes Vaughan APRN

“I just love getting my period,” said no woman ever! But ladies, unless you’re menopausal, pregnant, breastfeeding, post-surgery, or on hormonal contraception that suppresses your period, not having a period can be detrimental.

As many experts say, the period is considered the “fifth vital sign,” and I just love this concept!


Your period is a key indicator of your overall health, not just your fertility.


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Healthcare professionals are concerned about two types of amenorrhea (primary amenorrhea and secondary amenorrhea) as well as irregular periods (oligomenorrhea).


Amenorrhea simply means lack of a period.


Primary amenorrhea essentially means that a female has not gotten her period by the age of 15. This could be normal and due to later puberty, but is absolutely cause for a trip to your healthcare provider.

Secondary amenorrhea is defined as the absence of menses (period bleeding) for six or more months, or the length of three cycles after the establishment of regular menstrual cycles.

For instance, you have not had a period for six months or your period stopped for three typical cycles (i.e. if you have a 31 day cycle, you have not had a cycle for over 93 days).

Oligomenorrhea is also of concern and means infrequent, irregular periods (i.e. fewer than 6-8 periods per year). We’re going to focus on secondary amenorrhea and oligomenorrhea for the purpose of this article.

Now missing a period here and there can be common. If you’ve recently traveled, work night shift, had a drastic change in your schedule, taken certain medications such as a steroid, immune suppressant, estrogen receptor blocker, etc, or just endured a stressful couple of weeks, it’s not worth panicking over right away.

However, if you are noticing that your period is consistently inconsistent/irregular or you are truly experiencing secondary amenorrhea as defined above, even if you’re not trying to get pregnant, please don’t ignore this vital signal that something may be off.

There are several abnormal causes of secondary amenorrhea and oligomenorrhea. For instance, extreme chronic stress that may impact hormone levels, polycystic ovarian syndrome (PCOS), thyroid disease, pituitary adenoma (tumor), or lack of adequate calories in the diet.

Other causes are extreme exercise, uterine structural abnormalities (i.e. endometrial adhesions or scarring of the uterine wall (Asherman Syndrome), autoimmune disorders, premature menopause (menopause before the age of 40), and early menopause (menopause between the age of 40-45)…to name a few.


Here’s the problem, if you’re not having a monthly, regular period, a few things can be happening in your body that may be harmful.


One such issue is potentially build up of the uterine lining. When you’re amenorrheic (with exception the previously mentioned non-concerning causes) your uterine lining could be building up over time.

Eventually, if this occurs chronically, the build up can lead to endometrial hyperplasia (abnormal thickening of the uterine lining) that can ultimately grow out of control and develop into uterine cancer.

Another issue, if your lack of period is due to inadequate hormone levels (i.e. low estrogen), you are at a greater risk of bone loss and early osteoporosis. These are just a couple of examples.

Therefore, absent or irregular periods should absolutely be evaluated and addressed thoroughly, not only to improve and preserve your fertility, but also protect your bones, reduce cancer risk, and prevent development of multiple associated health problems that could ensue.

What to do if this is hitting close to home? First, I always recommend taking a pregnancy test if you are sexually active. Then, evaluate your stress levels, travel schedule, diet, exercise regimen. Anything stand out with those?

Also, consider if you are having any associated symptoms such as hot flashes and night sweats, hair loss, brittle nails, weight loss or gain, vaginal and skin dryness, fatigue, decreased libido, abnormal facial or chest hair, increase acne, or anything that just does not seem normal to you. Write all of these down. They are clues. 

Second, make an appointment with a licensed healthcare professional. Find someone who you are comfortable with, someone who is willing to take a whole-istic approach by looking at the entire picture and searching for the root cause rather than just giving you a prescription.

Someone who will take the time to listen and explain your situation in detail. Take all of your notes with you to your visit and lay them out to give your provider a full understanding of what’s been going on.

Third, take care of yourself. That doesn’t just mean a balanced diet and moderate exercise routine. That means taking time to rest. Engage in healthy relationships and walk away from harmful ones. Say no to things that are straining you. Nourish both your body and your soul.

Lastly, when you see your healthcare provider. The approach is simple. First, we’ll listen to your history. Second, often a physical assessment will be performed. The provider will typically examine the face, neck, breasts, and abdomen as well as perform a pelvic exam.

Depending upon the individual, proper lab testing will be performed. Also, sometimes the provider will determine if an ultrasound is needed. Treatment is tailored based upon the whole picture.

Don’t ever settle for a pill without an explanation. While medication is sometimes necessary, it’s always important for you to know “why”.

Trust me, your health and your future are worth it!


References

American College of Gynecology. (2017). Gynecology Data Definitions.

Welt, K.W., Crowley, W.F., Martin, K.A.. (2019, April 3). Patient Education: Absent or Irregular Periods. Beyond the Basics.


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Brookes is a Board Certified Women’s Health Nurse Practitioner. She is the founder, CEO and healthcare provider of Girl Health Co., a virtual women’s health clinic and online community.


THE INFORMATION CONTAINED HEREIN IS FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT YOUR HEALTH CARE PROVIDER.