Amenorrhea is a condition not menstruation or no menstruation. This condition can be divided into 2 types, namely primary and secondary amenorrhea. Amenorrhea needs to be treated because it can be a sign of a serious disease. One of them is a tumor on the pituitary gland.
Please note, that normally before entering puberty, during pregnancy, breastfeeding, or when entering the menopause phase, women will not experience menstruation.
Outside of these conditions and phases, if a woman does not have her first menstruation or does not have her period again, a thorough examination is needed to determine the causes and triggering factors.
Causes of Amenorrhea
Amenorrhea can be caused by various conditions, ranging from disorders of the reproductive organs, tumors of the pituitary gland, to hormonal disorders. If described further, here are some conditions or diseases that can cause amenorrhea:
Disorders of the reproductive organs
Some disorders in the reproductive organs that can cause menstruation not to occur are:
- Absence of the uterus, cervix (cervix), or vagina
- The presence of scar tissue in the uterus due to Asherman's syndrome, complications of curettage, or complications of cesarean section
- Presence of obstruction or blockage in the reproductive tract
Hormonal disorders
Diseases and conditions that can cause hormonal disturbances and trigger amenorrhea include:
- Thyroid disorders, including hyperthyroidism or hypothyroidism
- Pituitary gland tumors
- Ovarian tumor
- Excess prolactin hormone
- PCOS (polycystic ovary syndrome)
- Excessive exercise and activity
- Continuous and poorly managed stress
- Use of drugs or hormone preparations, including birth control injections
- Too low body weight, including due to eating disorders, such as anorexia or bulimia
- Primary ovarian insufficiency, i.e. the ovaries stop working before the age of 40
- Total hysterectomy, so that all parts of the uterus including the ovaries are removed
In addition to the causes mentioned above, the risk of developing amenorrhea is also increased in women who have a family history of the condition or are undergoing vigorous exercise training.
Symptoms of Amenorrhea
Menstruation or menstruation is the process of shedding of the uterine wall due to the absence of a fertilized egg. This condition generally occurs every 21-35 days and is characterized by vaginal bleeding that lasts for 2-7 days.
Normally, menstruation will begin to occur at the age of 11-14 years and stop when entering menopause. When experiencing amenorrhea, there is no menstruation or menstruation. Amenorrhea can be divided into 2 types, namely:
- Primary amenorrhea, which is a condition that occurs in women aged 14-16 years who do not have menstruation even though they have shown signs of puberty.
- Secondary amenorrhea, which is a condition that occurs in women of childbearing age who have had menstruation before and are not pregnant, but have not experienced menstruation for 3 consecutive cycles or more.
In addition to not having menstruation, amenorrhea can also be accompanied by several other symptoms depending on the underlying cause of the amenorrhea.
If it is caused by hormonal disorders, additional complaints may arise, such as excessive hair growth, changes in the voice that become heavier, acne, breast milk release when not breastfeeding, or hair loss.
When to go to the doctor
Check with your doctor if you haven't had your period for 3 consecutive cycles or haven't had your first period at the age of more than 15 years, especially if you have other complaints, as mentioned above.
If you have been diagnosed with amenorrhea, check with your doctor regularly. In addition to monitoring the results of treatment, this routine examination also aims to reduce the risk of complications.
Diagnosis of Amenorrhea
To diagnose amenorrhea, the doctor will ask questions about complaints, whether there are changes in diet or exercise, previous use of certain drugs, and your and your family's medical history.
Next, the doctor will perform a thorough examination, including an examination of the pelvic area and reproductive organs.
To confirm the diagnosis, the doctor will perform supporting examinations in the form of:
- Pregnancy test, to determine whether amenorrhea is caused by pregnancy or not, especially for sexually active women of childbearing age
- Blood tests which include examination of the hormones prolactin, thyroid, estrogen, FSH (follicle-stimulating hormone), DHEA-S (dehydroepiandrosterone sulfate), or testosterone, to determine whether there are hormonal disorders that can cause amenorrhea
- Scan tests with ultrasound, CT scan, or MRI, to see whether there are abnormalities in the reproductive organs and tumors in the pituitary gland (pituitary)
Amenorrhea Treatment
Treatment for amenorrhea will be determined based on the underlying cause. Some of the treatment options that can be given to treat amenorrhea are:
1. Administration of drugs and hormonal therapy
Drugs and hormonal therapy are given to trigger the menstrual cycle and treat hormonal disorders. Several types of drugs that can be given to trigger the menstrual cycle are birth control pills, preparations or drugs containing progestogens, GnRH-a analogues (GnRH-a).gonadotropin releasing hormone analogue), or bromocriptine.
Meanwhile, hormone replacement therapy to treat amenorrhea will be adjusted to the underlying cause. Some types of hormone therapy that can be given are:
- Estrogen hormone replacement therapy (ERT), for amenorrhea caused by primary ovarian insufficiency, this therapy will be balanced with the administration of progestin or the hormone progesterone to reduce the risk of uterine cancer
- Androgen-reducing therapy, for amenorrhea caused by polycystic ovary syndrome (PCOS)
2. Lifestyle changes
If amenorrhea is triggered by an unhealthy lifestyle, the doctor will recommend implementing a healthy lifestyle by doing the following things:
- Maintain ideal body weight
- Managing stress
- Exercise regularly
- Eat nutritious food
- Get enough rest
3. Operation
Although rarely done, if the amenorrhea is caused by a tumor or there is scar tissue, surgical removal of the tumor or scar tissue may be performed.
Complications of Amenorrhea
Complications of amenorrhea depend on the underlying cause. If amenorrhea occurs due to the absence of ovulation, infertility can occur. If caused by hormonal disorders, such as lack of estrogen levels, the risk of osteoporosis can also increase.
Prevention of Amenorrhea
Amenorrhea can not always be prevented, especially if it is caused by disorders of the reproductive organs, such as the absence of the uterus, cervix, or vagina.
If your child doesn't have a period at the age of 15 even though signs of puberty have appeared, check with a doctor, so that the cause can be identified immediately.
In addition, if amenorrhea is related to your lifestyle, you can lower your risk by doing the following:
- Maintain an ideal body weight by eating a healthy and balanced diet
- Managing stress the right way
- Exercise regularly
- Get enough rest
- Always consult a doctor before using any medications or supplements