Amenorrhea is the absence of menstruation, which can be primary, when menstruation is not enough for adolescents aged 14 to 16, or secondary, when menstruation stops coming, in women who have already menstruated.
Amenorrhea can happen for several causes, some natural, such as pregnancy, breastfeeding or continuous use of contraceptives, or for some diseases, from defects in the woman's reproductive system, changes in hormones of the ovaries, and even be caused by stress, disorders eating habits or excessive physical exercise.
Types of amenorrhea
The absence of menstruation can happen for several reasons, being classified in 2 types:
- Primary amenorrhea: it is when the menstruation of girls aged 14 to 16 years does not appear, as would be expected by the period of body development. In these cases, the gynecologist will perform the clinical examination and order blood and ultrasound tests, to investigate whether there are anatomical changes in the reproductive system or changes in hormones, such as estrogen, progesterone, prolactin, TSH, FSH and LH. Secondary amenorrhea: happens when menstruation stops for some reason, in women who had menstruated previously, for 3 months, when menstruation was regular or for 6 months, when menstruation was irregular. The investigation is also done by the gynecologist, with clinical gynecological examination, hormone measurements, in addition to transvaginal or pelvic ultrasound.
It is important to get tested for pregnancy whenever there is amenorrhea, as it is possible to get pregnant even in cases of irregular menstrual cycle or that was absent for a long time.
Main causes
The main causes of amenorrhea are pregnancy, breastfeeding and menopause, which are natural causes of the organism, in periods when changes in the levels of the hormones progesterone and estrogen are common.
However, other causes of amenorrhea are caused by illness, medication or habits, such as:
| Causes | Examples |
| Hormonal imbalance |
- Changes in hormones, such as excess prolactin, testosterone, hyper or hypothyroidism; - Brain changes, such as deregulation or pituitary tumor; - Polycystic ovary syndrome; - Early menopause. |
|
Reproductive system changes |
- Absence of uterus or ovaries; - Changes in the structure of the vagina; - Imperforate hymen, when menstruation has nowhere to go; - Uterine scars or Asherman's syndrome; |
| Ovulation inhibited by lifestyle habits |
- Eating disorders, such as anorexia; - Excessive physical activity, common in athletes; - Very rapid weight loss; - Obesity; - Depression, anxiety. |
| Medicines |
- Contraceptives for continuous use; - Antidepressants, such as amitriptyline, fluoxetine; - Anticonvulsants, such as phenytoin; - Antipsychotic, such as haldol, risperidone; - Antihistamines, such as ranitidine, cimetidine; - Chemotherapy. |
How to treat
The treatment for amenorrhea depends on the cause, being done with the guidance of the gynecologist, who will determine the best option for each case. So, some options are:
- Correction of the body's hormone levels: includes the use of drugs to control levels of prolactin and testosterone, for example, or replacement of estrogen and progesterone levels to keep hormone levels regulated. Changing lifestyle habits: how to lose weight, have a balanced and healthy diet, practice moderate physical activity, in addition to treating depression and anxiety, if any, according to the psychiatrist's guidance. Surgery: can reestablish menstruation and increase the possibility of becoming pregnant, as in the imperforate hymen, uterine scars and some changes in the vagina. However, when the uterus and ovary are absent, ovulation or menstruation cannot be established.
Natural treatments can help in some cases of delayed menstruation due to changes in the menstrual cycle, in women without significant hormone dysregulation or other diseases, and some examples are cinnamon tea and agonized tea. See more about what to do and tea recipes for late menstruation.
Is it possible to get pregnant with amenorrhea
The possibility of pregnancy, in cases of amenorrhea, depends on the cause. The correction of hormones for the normal functioning of the ovaries, can regulate ovulations and fertility, or they can be induced with the use of medications, such as Clomiphene, for example, which allows pregnancy naturally.
In cases of absence of the ovary, it is also possible to have a pregnancy, by donating eggs. However, in cases of absence of uterus, or major deformities of the reproductive system, which are not resolved with surgery, pregnancy is not possible at first.
It is important to remember that women who have irregular periods can become pregnant, although it is more difficult, and therefore precautions should be taken to avoid unwanted pregnancies. A conversation with the gynecologist should be carried out so that the possibilities and treatments for each woman are evaluated, according to their needs and wants, in relation to pregnancy and contraceptive methods.
