Amenorrhea • No period

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Important period warning signs

What is amenorrhea?

Amenorrhea is perfectly normal during pregnancy, breastfeeding, and the onset of menopause. In the fertile years, on the other hand, it is considered a menstrual disorder if you miss your period. There are two types of amenorrhea:

• In the primary amenorrhea there has been no menstrual period beyond the age of 16.

• A secondary amenorrhea is when the menstruation has not occurred for at least three months, but the woman has already had menstrual bleeding beforehand.

Amenorrhea: what are the causes?

For one primary amenorrhea chromosomal disorders are responsible in a third of the cases, for example Turner syndrome, Klinefelter syndrome or Swyer syndrome. In two thirds of the cases, there is an organic disorder behind this: ovaries that are not fully developed, a blocked cervix or a completely closed hymen prevent regular menstrual bleeding. Hormonal disorders can also trigger amenorrhea, including, for example, an underactive thyroid or polycystic ovarian syndrome (PCO). In rare cases, primary amenorrhea occurs as a side effect of diseases such as cancer or diabetes.

Secondary amenorrhoea often have a psychological background. That’s because hormones control the menstrual cycle. These are in turn regulated by the brain. If there is no menstrual period, the causes can often be found in the hormone-producing or controlling areas of the brain: the pituitary gland, hypothalamus and thus also in the metabolism. This is prone to stress because so-called stress hormones are released through psychological stress, which can severely disrupt the hormonal interaction.

Typical psychological causes of secondary amenorrhea are:

• Stress, burnout

• severe weight fluctuations due to frequent diets

• Underweight due to anorexia

• Excessive sport or other extreme situations

Medication can also trigger amenorrhea. For example, there is post-pill amenorrhea, which occurs after stopping the birth control pill. Antidepressants, antihypertensive drugs, and chemotherapy can also lead to missed periods. Pathological changes in the uterus (e.g. endometriosis) or a hormone-producing tumor in the ovaries or the pituitary gland are only very rarely the cause of amenorrhea.

Symptoms of amenorrhea

Menstruation is part of a woman’s cycle that her body uses to prepare for pregnancy month after month. If this does not occur, the body expels the lining of the uterus – the periodic bleeding is colloquially called “period” or “rule”. The first menstrual period is menarche, which usually occurs between the ages of 11 and 14 years, the last menstruation occurs on average at the age of 51.

The main symptom of amenorrhea is the absence of menstruation. Depending on the cause of the amenorrhea, other symptoms may sometimes appear:

• Changes in breast size

• milky discharge from the chest

• Fluctuations in weight

• acne

• increased hair growth on the face

• Hair loss

• Headache or blurred vision

• vaginal dryness

• deeper voice

Investigations in amenorrhea

If menstruation is absent for more than three months, a doctor’s visit is necessary. The treating gynecologist will first rule out pregnancy and the onset of menopause. In a detailed conversation (anamnesis) she * he gets to the bottom of various questions:

• When did the first and last normal menstrual periods take place?

• Has the period always been regular? How long is the cycle usually?

• How long and how heavy is the bleeding usually?

• Does the person suffer from cyclical breast tenderness and mood swings?

• Were there significant weight fluctuations? Are there any other symptoms?

• Are there any chronic diseases (also in the family)? What medications are being taken?

• What is the stress level like?

Anamnesis, gynecological examination, ultrasound and determination of the hormone status can already clarify 95 percent of cases of amenorrhea. To determine the hormone status, the FSH, TSH, LH, prolactin and testosterone levels are determined using a blood sample. A genetic test may be done if primary amenorrhea is suspected. An abdominal or uterine specimen provides information about irregularities in the abdominal and pelvic area, while magnetic resonance imaging (MRI) or computed tomography can detect malformations or tumors.

Treat amenorrhea

The therapy for amenorrhea depends on the underlying clinical picture.

• In the event of a hormonal disorder, appropriate hormone preparations are prescribed. The cycle regulates itself and the menstrual period comes back. Even a desire to have children can often be fulfilled.

• Tumors or malformations of the genital organs can often only be brought under control with an operation.

• If there is a Y chromosome, doctors recommend surgical removal of the ovaries because of the increased risk of cancer.

If the primary or secondary amenorrhea is lifestyle-related, the following measures are recommended:

• Regulation of overweight or underweight

• moderate sport

• Stress reduction

• Psychotherapy helps you to get a better grip on eating disorders and psychological stress. Menstrual disorders are often regulated with a balanced emotional balance.

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