Various forms of menstrual disorders, such as a strong or weak menstruation, can occur in any woman in all circumstances, without having a pathological background. However, if the period is absent completely over a long period of time, the gynecologist speaks of amenorrhea. Its causes are manifold, and therapy is carried out with hormones according to the cause.
What does absence of the period mean?
The term amenorrhea is derived from the Greek words a (“without”), menos (“month”), and rhoe (“flow”) and refers to the absence of menstruation. Basically, the pathological absence of menstruation must be distinguished from natural, physiological amenorrhea. The latter occurs before the first period, i.e. in childhood and puberty, during pregnancy and lactation, and in postmenopause, and is not problematic for the woman. Initially, any form of amenorrhea that occurs in women of sexually mature age is referred to as a cycle disorder requiring treatment. Gynecologists distinguish between primary and secondary amenorrhea. Primary amenorrhea is diagnosed when young women have not had a period after their 16th birthday. Secondary amenorrhea refers to the absence of periods for more than three months in women who have already had a menstrual period.
Causes
Numerous causes may be responsible for missed periods. The most important organic causes of amenorrhea are disorders of ovarian function, as can occur in ovarian inflammation and PCO syndrome. A hymen that is too tight can also cause amenorrhea. Other possible causes of missed periods include metabolic diseases and hormonal imbalances. These include hypothyroidism, adrenal insufficiency, and diseases of the pituitary gland. The best known non-organic causes are stress and prolonged psychological strain. The change of climate after moving abroad also upsets the female hormonal balance and, like taking medication and stopping the pill, can lead to amenorrhea. In addition, a risk factor for the absence of periods is severe underweight, as can occur in anorexia or bulimia.
Symptoms, complaints, and signs
By definition, a missed period is when the period is completely missed in one cycle. If it occurs a few days late, it is not an absence, but a delay. The absence of the period is noticeable by the fact that there is no menstruation at the expected time. The most common cause of missed periods is pregnancy. However, periods can also be missed under great stress, emotional strain and general, even physical, overload. Other reasons can be a deficiency of certain nutrients and minerals. In this case, a blood count will provide information. With the absence of the period, the typical period pains are also absent. However, the symptoms of PMS, or premenstrual syndrome, which precede the period, may still occur. In the menopause, periods become irregular at first, then stop more and more frequently until they finally stop altogether. This is a completely natural development that is no cause for alarm. Nevertheless, the gynecologist should be consulted for a definite diagnosis. A constantly irregular period that stops now and then is also no cause for alarm. The causes can usually be found quickly and remedied with appropriate therapy.
Diagnosis and course
In order to make a diagnosis and locate the cause, the gynecologist must first take a detailed medical history. The gynecologist needs to know when the first period occurred, what the cycle behavior was like in recent months, whether the patient has any known metabolic disorders or family risks, what medications the patient is taking, and whether there are any psychological stresses. Patients often have to keep a cycle diary for several weeks or months, in which the morning body temperature and cycle-related abnormalities are recorded. A gynecological examination of the vagina, uterus and ovaries, often using imaging techniques, is also informative. Examination of blood and urine can also provide clues to the cause of amenorrhea.With adequate therapy, there is a good chance of rapid normalization of the cycle.
Complications
The absence of periods (amenorrhea) can have many causes; some of them can lead to complications. First, of course, there may be pregnancy, which must be confirmed by a doctor to avoid problems later. Complications can occur if the egg has not nested inside the uterus, because then there is a risk of a potentially life-threatening ectopic pregnancy. The absence of menstruation as a result of a hormonal disorder can, if left untreated, lead to further mental illness and a variety of complications. If the symptoms are due to a tumor, the possible complications range from a reduction in well-being and pain to infections and other secondary diseases. Amenorrhea before menopause usually causes a decrease in fertility and is associated with various physical and hormonal changes. Depending on the woman’s constitution and the severity of amenorrhea, it can lead to a variety of complications, such as premature aging and stress-related diseases. Chronic absence of periods (secondary amenorrhea) may be due to various underlying conditions such as constriction of the pituitary gland or circulatory disorders. Possible complications range from discomfort to unwanted pregnancy. Because the complications of missed periods are as varied as the possible underlying conditions, amenorrhea should always be evaluated by a gynecologist.
When should you see a doctor?
The absence of periods is not in itself necessarily a reason to see a doctor. Rather, the absence of the period should be classified in the individual health situation. Especially in very young women in puberty, the monthly cycle is not yet regular. However, this is not a medical condition. After childbirth, during breastfeeding or in phases of great stress, periods may stop due to a change in hormones. If there are no other abdominal complaints, you can wait a few cycles and give the body a chance to regenerate itself. However, if the period does not resume on its own and abdominal pain occurs, a gynecological examination is advisable. On the one hand, the absence of the period may indicate an unexpected pregnancy, which must be accompanied by a doctor. On the other hand, in rare cases, bleeding may stop due to benign or malignant neoplasms in the abdomen. Since early detection plays an important role here, a timely visit to the doctor makes sense.
Treatment and therapy
Treatment of amenorrhea is cause-related and individually tailored. If a hormone disorder is the cause, the treating physician will initiate hormone therapy to normalize hormone levels and thus stabilize the cycle. The dosage and determination of the hormones to be administered depends on the exact horn disorder present, because the therapy of hypothyroidism, for example, requires different hormones than that of adrenal dysfunction. If an organ dysfunction is present, surgical therapy must be considered. A hymen that is too tight can be pierced by the gynecologist, other organic causes must be removed under general anesthesia. Treatment of psychological or stress-induced amenorrhea involves, depending on the severity, measures to help the affected person rest and relax. Psychotherapy should also be considered. If severe psychological distress is present, the administration of psychotropic drugs may be considered to re-stabilize the patient. However, this must be well weighed because of the risk of side effects. Therapy for anorexia or bulimia nervosa is lengthy and requires learning healthy eating behaviors that are gentle on the cycle and psychotherapeutic measures.
Outlook and prognosis
In keeping with the fact that a distinction is made between primary and secondary amenorrhea, the prognoses are also highly variable. The only case that allows a clear prognosis is the onset of menopause in women: periods are not expected to return. However, individual menstrual periods may still occur during the hormonal transition at this time. Eventually, it succumbs completely after a few years.Pregnancy and breastfeeding are also temporary inhibitors of periods. Primary amenorrhea usually has organic or hormonal causes and can be treated accordingly by surgery or hormone therapy. If the organs involved are functional but inhibited, for example, by a correctable malformation or due to dysregulated hormones, the prognosis is good. Such malfunctions can often be corrected. The situation is different if parts of the woman’s fertility apparatus are incorrectly or non-functionally formed. Secondary amenorrhea can have numerous causes, ranging from malnutrition to pregnancy to psychological stress. Climatic changes may also be a factor. The prognosis depends solely on the cause, although many environmental factors can be compensated. Normalization of psychological stress or a change in diet is usually sufficient to restart the period. Tumors, infections, etc. are another factor. Often menstruation can return after treatment. Permanent amenorrhea that cannot be attributed to pregnancy, menopause, or lactation means a loss of fertility for the woman in the absence of successful treatment, which can have even more consequences psychologically.
Prevention
Cyclic disorders cannot be prevented in principle. However, a healthy lifestyle and diet seem to minimize the risks of experiencing amenorrhea.
Follow-up
When periods are missed, there is by no means necessarily a medical condition. During pregnancy and breastfeeding, the absence of menstruation is quite normal. The situation is similar during menopause. Here, follow-up care is therefore of little use, since no disease is present. The situation is different for other causes. There are a number of possibilities. The doctor performs palpation examinations. Ultrasound images and computer tomographies lead to a conclusive result. After the period has missed once, it can happen again for the same or other reasons. The body does not build up immunity. The goal of follow-up care should also be to prevent complications. The absence of the period usually occurs in the context of other complaints. If the absence is due to hormonal problems, long-term hormonal treatment usually follows. If, on the other hand, psychological difficulties are the main cause, the doctor may prescribe psychotherapy. If tumors lead to the absence of menstruation, surgery or chemotherapy is sometimes necessary. General behavioral tips for a normal menstrual period are difficult to formulate. Sometimes physicians use the term balance. Those who find their inner center, eat a balanced diet, exercise and maintain social contacts usually build up a regular cycle.
Here’s what you can do yourself
In the absence of periods should first talk to the gynecologist, for example, to rule out a disease or pregnancy. In addition, a healthy diet is recommended above all. Fruits and vegetables, legumes, whole grains and nuts regulate the intestinal flora and thus usually also normalize the cycle. Sometimes digestive foods such as flaxseed or prunes also help. Natural remedies such as maca can help with hormone imbalances. The root from the Andes can be taken as a powder or in the form of capsules and effectively promotes menstruation. If the absence of the period has stress or emotional problems as a cause, calming herbs such as lemon balm, passion flower, lime blossom or valerian can help. Bach flowers also counteract emotional discomfort in a natural way. However, in order to achieve a normal menstrual period in the long term, the triggers of the complaints should also be eliminated, for example by changing the environment or the profession or by talking to a therapist. Finally, the cycle can be regulated by light. So-called “lunar receptivity,” which involves sleeping in different light conditions during the cycle, can stimulate ovulation and counteract the absence of periods.