Amenorrhea is, by definition, an absence of menstruation. There are two types. Primary amenorrhea concerns women and young girls over the age of 16 who have never had a period. Secondary amenorrhea occurs occasionally in the life of a previously menstruating woman who observes an absence of menstruation for more than three months. In the first case, which is rarer, it is advisable to carry out a specialist, hormonal and/or genetic assessment.
The causes of secondary amenorrhea
If a woman notices a missed period, the first thing to do is a pregnancy test. “It is the first cause of secondary amenorrhea“, selon Odile Bagot, “especially if you have always had regular periods and there have been no physical changes, and even if you think you have taken your contraception correctly“. Indeed, pregnancy interrupts the production of estrogen, which marks the absence of periods.
Otherwise, one of the most common causes of the absence of menstrual flow in young women is being underweight, whether it results from anorexia nervosa or excessive sport. “We often see it in young dancers, for example, with finer morphologies, or in high-level sportswomen.“explains Odile Bagot.
“In this situation, you have to be very careful.“continues the gynecologist, because addressing amenorrhea caused by being underweight requires questioning the person’s eating disorders (ED). “When the fat mass is insufficient, the production of estrogen is too, but to have periods you must produce estrogen” explains Odile Bagot. In these amenorrhea linked to a TCA or intensive sport, estrogen deficiency must be monitored, because in the long term, it can be responsible for bone loss, or even osteoporosis. “In this situation, the healthcare professional will measure the estrogen level, and if it is too low, supplement the woman with estrogen, either via an estrogen-progestogen pill or hormonal treatment.“.
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Otherwise, other rarer causes can explain amenorrhea in a woman who is neither pregnant nor prone to a weight problem.
“In a person under 40 who no longer has periods, the question of primary ovarian failure, or early menopause, can be raised. A hormonal assessment can demonstrate this”. And if from the age of 45 a woman has not had her period for at least a year, it is certainly menopause, and therefore a definitive amenorrhea.
Polycystic Ovary Syndrome (PCOS)an endocrine pathology that affects regarding one in ten women, is responsible for spaniomenorrhea, i.e. very rare periods (2 to 4 times a year).
The continuous pill and the progesterone IUD lead to induced amenorrhea. “Even on a low-dose pill, following a while the endometrium becomes so thin that menstruation may no longer occur.“says the gynecologist.
More rare, uterine synechiae (two tissues of the uterus stick together abnormally), which occur most of the time following curettage, can give amenorrhea.
Finally, chemotherapy can also cause amenorrhea.
Can stress cause amenorrhea?
“Stress alters the cycle in every way: it can cause menstruation to come earlier, later, less strong, stronger“, explains Odile Bagot. “We are not robots, transient amenorrhea (delayed periods) is completely normal. If it lasts, it’s secondary amenorrhea, and we’ll check physical activity, weight and pregnancy test to determine the cause.”
Treatments
There is no specific treatment for amenorrhea. “It depends on the cause: if it is an early menopause, and the woman wants a child, there is no other solution than egg donation. If it is related to anorexia nervosa, there is no other treatment than to regain weight. In case of PCOS, and if there is a desire for pregnancy, ovulation stimulation will be recommended“, ends the gynecologist, before specifying that “for periods of iterative amenorrhea, you just have to wait for it to come back”.
The expert
Dr. Odile Bagot is a gynecologist, specializing in gyneco-obstetrics, and also hosts the blog Mom Gyneco.
Son Doctolib : Dr Odile Bagot
