Amenorrhea is the medical term for the absence of periods (menstruation). There are two types: primary amenorrhea, when you have never had your period, and secondary amenorrhea, when your periods disappear after you had had regular periods before.
Primary amenorrhea (you never had your period)
What is it about ?
With primary amenorrhea, it often happens that the ovaries do not function properly due to a birth defect. Other causes of amenorrhea are possible: an abnormality in the uterus or fallopian tubes, a problem in the brain, a dysfunction of the organism (eg. hypothyroidism, gluten intolerance untreated), too strict a fast (anorexia) or excessive exercise. Other hormonal disorders (eg. polycystic ovary syndrome (PCOS)), chromosomal abnormalities or excess weight are also possible causes.
Additional examinations are required in two cases:
- you are at least 16 years old and have never had your period, although your puberty is progressing normally;
- you are 13 or 14 years old, you have never had your period and you have no signs of puberty (breast development or pubic hair).
How to recognize it?
If you don’t have your period by age 16, or if you don’t have any signs of puberty by age 13 or 14, it is primary amenorrhea.
How is the diagnosis made?
The doctor will make the diagnosis based on your story. Your GP will examine your growth and signs of puberty. It will link this data to your medical history and information about the progress of your parents’ puberty. You will then be referred to a pediatrician or gynecologist.
What can you do ?
Eat normally, maintain a normal weight and play sports without going overboard. If you play sports intensively, make sure you eat enough.
What can your doctor do?
The general practitioner will refer you to a specialist for further examinations in order to identify the exact cause of amenorrhea.
Secondary amenorrhea (disappearance of periods)
What is it about ?
If you haven’t had your period for three cycles or for more than six months, this is secondary amenorrhea. Possible causes are pregnancy, the onset of menopause, or hormonal problems in the brain, thyroid or ovaries. Certain medications and illnesses, previous cancer treatment, severe excess weight or extreme weight loss, excessive exercise and stress can also be responsible.
How to recognize it?
You have secondary amenorrhea if you haven’t had your period for 3 cycles or more than 6 months.
How is the diagnosis made?
If you have stopped having your period and you know the date of your last period, your doctor may diagnose secondary amenorrhea based on this information. He will ask you more questions and do a blood test to try to identify the cause.
What can you do ?
If you haven’t had your period for more than 4 weeks and there is a possibility that you are pregnant, take a pregnancy test. If you notice any physical or psychological changes such as excessive fatigue, mood swings, discharge of milk from the nipple, or abnormal changes in your weight, do not hesitate to tell your doctor. If you want to lose weight, avoid extreme diets and excessive exercise. If necessary, have a professional accompany you instead. You can also seek advice from your general practitioner in order to manage your stress.
What can your doctor do?
A blood test is necessary to rule out pregnancy and detect possible hormonal problems. Your GP will possibly prescribe hormone therapy to induce your period. In some cases, he will refer you to a gynecologist and / or a doctor specializing in hormones (an endocrinologist).
If you are overweight, dietary monitoring may be necessary. If the cause is stress or taking certain medications, your doctor will discuss this with you.
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Source
Foreign clinical practice guidelines’ Amenorrhea‘(2000), updated on 01.07.2016 and adapted to the Belgian context on 28.03.2018 – ebpracticenet