Question? I have not had my menstrual period for three months and am not pregnant because I have tested several times. What do you think is wrong with me?
A woman who has missed at least three menstrual periods in a row has amenorrhea, and should be evaluated by a physician. Amenorrhea is not a disease itself, but a sympton of an underlying disorder. The most common cause is pregnancy. Even though a woman has tested herself several times with home pregnancy tests, and the tests were all negative, a pregnancy test ordered by your doctor is the first step in finding the cause of amenorrhea. You might experience other signs and symptoms, depending on the cause of the amenorrhea, such as: a milky nipple discharge, hair loss, headache, vision changes, and excess facial hair.
There are a number of possible causes of amenorrhea, including the normal course of a woman’s life, a side effect of medications, or a medical problem. Amenorrhea occurs naturally during pregnancy, breast-feeding, and menopause.
Some of the medications which can stop menstrual periods are: birth control pills, antipsychotics, cancer chemotherapy, antidepressants, and blood pressure pills.
Some lifestyle factors can cause amenorrhea. Mental stress can cause changes in the hypothalamus, an area in the brain that controls the hormones that regulate menstruation. After the stress decreases, periods will usually start again.
Excessively low body weight can trigger amenorrhea, and affect other body functions controlled by hormones. Eating disorders, such as bulimia or anorexia, can cause hormone changes that halt menstruation.
Sports that require rigorous training, such as long-distance running or gymnastics, can disrupt menstruation. In athletes, low body weight, rigorous training and stress can combine to halt menstruation.
Many medical problems can cause hormonal imbalances affecting menstruation, such as thyroid gland dysfuntion, benign pituitary (a gland near the brain) tumors, premature menopause, and polycystic ovary syndrome (PCOS), which causes constant high levels of hormones, rather than the normal fluctuation of hormones affecting menstruation.
Structural problems of the reproductive organs can cause amenorrhea, such as scarring within the uterus, congenital absence of sexual organs, and abnormal structure of the vagina.
Amenorrhea can cause complications, such as infertility, and osteoporosis later in life.
Finding the underlying cause of amenorrhea can take considerable time and testing. Your physician will order blood tests, which may include a pregnancy test, to rule out or confirm pregnancy. Thyroid function tests will determine if the thyroid gland is functioning properly. Ovarian function tests will determine if normal ovulation is taking place. Male hormone tests may be needed, especially if you have increased facial hair or a deepening voice. A hormone challenge test may be performed, in which hormonal medication is taken for 7-10 days to trigger menstrual bleeding. The results may reveal a lack of estrogen as the cause of amenorrhea.
Depending on the results of the blood tests, your signs and symptoms, and your personal history, the doctor may order imaging tests to visualize the reproductive organs. An ultrasound test will check for presence of the reproductive organs. A CT scan takes many X-ray images to indicate whether the uterus, ovaries and kidneys look normal. An MRI yields detailed images of the brain and surrounding glands. It can detect pituitary tumors.
If no specific cause is found, the doctor may recommend a hysteroscopy, in which a thin, lighted camera is passed through the vagina and cervix to visualize the inside of the uterus.
Treatment depends on the underlying cause of the amenorrhea. Birth control pills may restart your menstrual cycles. A thyroid or pituitary problem may be treated with medication. Surgery may be necessary to remove a pituitary tumor or to correct a structural abnormality.
Life style factors may need to be adjusted. A balance of work, recreation and rest is desirable. Reduce stress, and ask for help from your doctor, friends and/or family. Keep a record of your periods – the start date, how long it lasts, and any associated symptoms.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website.
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Article reviewed and approved by Dr. Didi Emokpare
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