AMENORRHEA

AMENORRHEA OR LACK OF MENSTRUES

 

Amenorrhea is the absence of menstruation in a woman of childbearing age. The word "amenorrhea" comes from the Greek for deprivation, even for month and rhein for flow.

From 2% to 5% of women would be affected by amenorrhea. This is a symptom and it is important to know the cause. The absence of periods is quite natural when, for example, a woman is pregnant, breastfeeding or approaching menopause. But outside of these situations, it can be a telltale sign of chronic stress or a health problem such as anorexia or a disorder of the thyroid gland.

 

Types of amenorrhea

 

  • Primary amenorrhea: when at the age of 16, your period has not yet been triggered. Secondary sexual characteristics (development of the breast, hair in the pubis and armpits and distribution of fatty tissue in the hips, buttocks and thighs) may nevertheless be present. 
  • Secondary amenorrhea: When a woman has had a period and stops menstruating for one reason or another, for a period equivalent to at least 3 intervals of previous menstrual cycles or 6 months without periods. 

 

The causes

 

There are many causes of amenorrhea. Here are the most common in descending order:

 

  • The pregnancy. The most common cause of secondary amenorrhea, it must be the first suspected in a sexually active woman. Surprisingly, it often happens that this cause is ruled out without prior checking, which is not without risk. Some treatments indicated to treat amenorrhea are contraindicated in pregnancy. And with commercially available tests, diagnosis is simple.
  • A minor delay in puberty. It is the most common cause of primary amenorrhea. The age of puberty is normally between 11 and 13 years old, but can vary a lot depending on ethnicity, geographic location, diet, and state of health. In developed countries, delayed puberty is common in young women who are very thin or athletic. It seems that these young women do not have enough body fat to allow the production of estrogen hormones. Estrogen allows the uterine wall to thicken, and later menstruation if the egg has not been fertilized by a sperm. In a way, the bodies of these young women naturally protect themselves and signal that their physical form is inadequate to support a pregnancy. If their secondary sexual characteristics are present (appearance of breasts, pubic hair and armpits), there is no need to worry before the age of 16 or 17 years. If signs of sexual maturation are still absent at the age of 14, a chromosomal problem (a single X sex chromosome instead of 2, a condition called Turner syndrome), a problem with development of the reproductive system or a hormonal problem.
  • Breastfeeding. Often, breastfeeding women do not have a period. However, it should be noted that they can still have ovulation during this period, and therefore a new pregnancy. Breastfeeding suspends ovulation and protects against pregnancy (99%) only if: - the baby is exclusively latching on; - the baby is less than 6 months old.
  • The onset of menopause. Menopause is the natural cessation of menstrual cycles that occurs in women between the ages of 45 and 55. The production of estrogen gradually decreases, causing periods to become irregular and then go away completely. You can ovulate sporadically for 2 years after you stop having your period.
  • Taking hormonal contraception. The “periods” which occur between two packets of pills are not periods linked to an ovulatory cycle, but “withdrawal” bleeding when the tablets are stopped. Some of these pills reduce bleeding, which sometimes after a few months or years of taking it, may no longer occur. Mirena® hormonal intrauterine device (IUD), injectable Depo-Provera®, continuous contraceptive pill, Norplant and Implanon implants can cause amenorrhea. It is not serious and demonstrates contraceptive efficacy: the user is often in a "hormonal state of pregnancy" and is not ovulating. It therefore has no cycle, no rules.
  • Stopping taking a contraceptive method (birth control pills, Depo-Provera®, Mirena® hormonal IUD) after several months or years of use. It may take a few months before the normal cycle of ovulation and menstruation is restored. It is called post-contraceptive amenorrhea. In fact, hormonal contraceptive methods reproduce the hormonal state of pregnancy, and can therefore suspend periods. These may therefore take some time to return after stopping the method, such as after pregnancy. This is particularly the case in women who had a very long (more than 35 days) and unpredictable cycle before taking the contraceptive method. Post-contraceptive amenorrhea is not problematic and does not compromise subsequent fertility. Women who find out they have fertility problems after contraception have had them before, but because of their contraception, they had not "tested" their fertility.
  • The practice of a discipline or a demanding sport such as marathon, bodybuilding, gymnastics or professional ballet. The "sportswoman's amenorrhea" is thought to be attributable to the insufficiency of fatty tissues as well as to the stress to which the body is subjected. There is a lack of estrogen in these women. It can also be for the body not to waste energy unnecessarily since it often undergoes a low calorie diet. Amenorrhea is 4 to 20 times more common in athletes than in the general population.
  • Stress or psychological shock. So-called psychogenic amenorrhea results from psychological stress (death in the family, divorce, job loss) or any other type of significant stress (travel, major changes in lifestyle, etc.). These conditions can temporarily interfere with the functioning of the hypothalamus and cause menstruation to stop for as long as the source of stress persists.
  • Rapid weight loss or pathological eating behavior. Too low a body weight can lead to a drop in estrogen production and a cessation of menstruation. In the majority of women who suffer from anorexia or bulimia, periods stop.
  • Excessive secretion of prolactin from the pituitary gland. Prolactin is a hormone that promotes mammary gland growth and lactation. Excess secretion of prolactin from the pituitary gland can be caused by a small tumor (which is always benign) or by certain medications (especially antidepressants). In the latter case, its treatment is simple: the rules reappear a few weeks after stopping the drug.
  • Obesity or excess weight
  • Taking certain medications such as oral corticosteroids, antidepressants, antipsychotics or chemotherapy. Drug addiction can also cause amenorrhea.
  • Uterine scars. Following surgery to treat uterine fibroids, endometrial resection, or sometimes a cesarean section, there may be a significant decrease in menstruation, or even transient or long-lasting amenorrhea.
  •  

The following causes are much less common.

 

  • An abnormality in the development of sexual organs of non-genetic origin. Androgen insensitivity syndrome is the presence, in an XY (genetically male) subject, of female-looking sex organs by lack of sensitivity of cells to male hormones. These "intersex" people with a feminine appearance consult at puberty for primary amenorrhea. The clinical and ultrasound examination allows the diagnosis: they do not have a uterus, and their sex glands (testes) are located in the abdomen.
  • Chronic or endocrine diseases. An ovarian tumor, polycystic ovary syndrome, hyperthyroidism, hypothyroidism, etc. Chronic diseases that are accompanied by significant weight loss (tuberculosis, cancer, rheumatoid arthritis or other systemic inflammatory disease, etc.).
  • Medical treatments. For example, surgical removal of the uterus or ovaries; cancer chemotherapy and radiotherapy.
  • An anatomical abnormality of the sexual organs. If the hymen is not perforated (imperforation), this can be accompanied by painful amenorrhea in a young girl who is pubescent: the first periods remain trapped in the vaginal cavity.

 

Symptoms

 

In a woman who has never had a period

  • No menstruation at age 14 and no development of secondary sexual characteristics.
  • No menstruation at the age of 16 despite the presence of development of secondary sexual characteristics.

In a woman who has had a previous period

  • Missing period for a period equivalent to at least 3 intervals of previous menstrual cycles or 6 months without periods.

 

Treatments

 

Hormonal treatments for amenorrhea due to:

 

- Dysfunction of the ovaries: hormonal treatment will be prescribed to promote the development of secondary hormonal characteristics and prevent osteoporosis.

- Menopause: combined hormone replacement therapy (estrogen + progesterone) is prescribed for women entering menopause. The rules are therefore maintained, but ovulation is absent. The benefits of this therapy for breast cancer are currently very controversial. Prescription is usually only given to women whose bothersome symptoms of menopause (hot flashes, mood swings) last a long time.

- Removal of the ovaries and uterus (before the presumed age of menopause): combined hormonal treatment (estrogen + progesterone) is prescribed, in particular for the prevention of osteoporosis.

 

Non-hormonal treatments for amenorrhea:

 

- In the case of amenorrhea due to an overproduction of prolactin (following a pituitary gland tumor, for example), the doctor will prescribe bromocriptine (Parlodel®). This drug is also prescribed as a dopamine agonist in Parkinson's disease.

- Surgery is sometimes performed for malformations of the reproductive system, but does not necessarily lead to a return of menstruation (especially in the case of significant malformations).

- Psychotherapy is strongly recommended if amenorrhea is due to trauma or pathological eating behavior (anorexia or bulimia).

 

Natural solution with Amenyl

 

Amenyl is a combination of several herbal remedies which corrects menstrual cycle disorders and restores the hormonal system over 3 months of treatment.