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What is Amenorrhea?

In this video, Dr. Barad discusses different kinds of menstrual dysfunction including Amenorrhea. CHR urges you to see a doctor as soon as possible if you begin to notice changes in your menstrual cycle, as that can often be a marker for other health problem.

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Amenorrhea, what is it?

A woman who is not having her regular monthly menstrual cycle is said to have, ¨Amenorrhea, ¨ meaning no menstrual cycle. Some women will have irregular menses, meaning every two or three months, and that’s called, ¨Oligomenorrhea.¨ Some women will not have a period at all for eight months to a year, and that would be amenorrhea.

Now, if one has never had a period in all of your life, you might have some problem that you were born with that didn’t allow your ovaries to develop in a way that you had normal menstrual cycles. On the other hand, if you were already 45 to 50 years old and your period is stopped, you might have menopause.

I think what’s more important is for women who are in the mid-reproductive age, who had a history of normal menstrual cycles, and then for some reason stopped having normal menstruation. There we have to do a full work up and see why is it that the menstruation, why the ovulatory cycles, have stopped, and a variety of endocrine reasons why that could be true, and a variety of tests that we’d have to do.

Of course, in order to have normal menstrual periods, you need to have normal hormonal function, but you also need to have a uterus that’s capable of responding to those hormones, building up a lining of the inside of the uterus (which is called endometrium), and then shedding it each month, which is obviously menstruation. There are times when a woman has had certain procedures, certain gynecologic surgical procedures, certain problems with the lining of her uterus. Sometimes you can have damage to the lining of the uterus when you have a DNC, or, especially, after you’ve had a miscarriage, where part of the lining uterus gets destroyed.

You need that basal lining of your uterus to regrow a normal endometrium. If that base is damaged or destroyed, you won’t regrow a normal endometrium, the same as if your lawn got swept away and there was just the bare dirt there, it wouldn’t be able to grow grass. So, you need to have that base in order to grow your normal endometrium and that’s called Asherman´s syndrome. So, there can be physical reasons why your uterus can’t respond to the normal hormones. So, to break it down, you need to have a uterus that can be normal responsive, you need to have hormones which cause the uterus to grow its endometrium, and you need to have the stimulus to make the ovaries produce those hormones.

Certain situations– stress, excessive exercise, excessive weight loss–can lead to the inability of sending the signal from your brain or pituitary to your ovaries and that can lead to amenorrhea. So, not having your menstrual period is a significant symptom that requires some careful history-taking and a few tests which can help us understand better why you’re experiencing this. In most cases, we’ll be able to come to a diagnosis, and hopefully be able to help you.

So, you might wonder if you’re experiencing some irregularity or loss of your mental cycles, when should you see a doctor? And I think the quick answer is– as soon as you have this kind of question. So, if you are a woman who in the past has had regular menstrual cycles, and for some unknown reason they’ve stopped, I would see a doctor. I wouldn’t wait. I would see a doctor relatively soon even if you’re not currently trying to get pregnant.

You want to understand what’s changed in you that’s led to this loss of menstruation and there could be other health consequences apart from fertility that could be there– certainly thyroid disorders or pituitary disorders. So, the occurrence of loss of your menstrual period in a woman who previously had regular menses can be a significant health problem or a significant symptom that needs to be investigated now. If you’re a woman who is just aging out of the reproductive process, you may still want to see your doctor because loss of your ovarian function means that you’re not going to have estrogen, there going to be changes that will occur, you have risk of losing bone calcium, any consequent increased risks of fractures, some vaginal dryness, discomfort with intercourse.

So, these are things that your doctor can help you with as well, but only if you’ve taken the time to see them and discuss your problems with them. The whole issue of whether to use hormone replacement treatment or not, it’s something that needs to be carefully discussed. There are some risks involved in taking hormones, but even if you don’t choose to take hormones, there are other things that help preserve your bones and can help you to feel better. So, if you don’t speak to your doctor, you won’t be able to learn about those.

For those women who have stopped having normal menstrual periods, but do still want to have children, it, again, is very important to see your doctor soon. In the case of some other endocrine problem that has led to loss of menstrual periods, you might easily fix that by fixing the endocrine problem.

In case of a diagnosis of amenorrhea secondary to stress or weight loss, just finding out that that’s the problem can help lead to the direction of the kind of treatment that you’ll need to help restore normal function. In the case of somebody with evidence of premature menopause, there may not be very much we can do except for a few experimental measures, but even there you could make a choice about whether you want to enter some experimental program or if you just want to be pragmatic and use eggs from somebody else, it could still help you to have a normal pregnancy. In the case of somebody who has stopped menstruating because they’ve had a physical problem with their uterus secondary to some previous surgery or a problem, that diagnosis could lead to a surgical correction.

So, it is important to see your doctor and there are many things we can do depending on what the actual problem is. Thank you.