Amenorrhea (absence of menstruation)
Over the years most women are likely to skip a period or two now and again, especially during times of stress. The holidays, special occasions, deadlines, changes in relationships, grieving, and traveling are just a few of life’s inevitable ups-and-downs that can alter your menstrual cycle. Just about any blip in your routine can cause you to have an anovulatory cycle — where you don’t produce an egg. This makes sense, when you think about it. Mother Nature is a great conservator, and when your life is off-kilter, it may not be an ideal time for your body to expend resources on offspring!
Given that this is a perfectly natural biological response, a missed period once or twice a year is a very common thing and nothing to worry about. But when you’re skipping periods on an ongoing basis, it’s a clear sign that the underlying imbalance is more profound — not just the result of a new job, moving house, or an unannounced visit from Great-aunt Mildred.
Skipping multiple periods may seem like a benign (maybe even convenient!) problem, but it can lead to more significant health issues over time, particularly with your fertility and bones, so it’s not something to ignore. Let’s look at what might be going on beneath the surface to cause it, starting with what type of amenorrhea you may be experiencing and what it can signify.
Types of amenorrhea
Amenorrhea is a diagnostic term used by healthcare providers when a woman who is not pregnant misses more than three consecutive periods, or if she spots and/or gets her periods very infrequently.
Primary amenorrhea is the term used to describe the complete absence of periods in a woman who has never initiated regular menstrual cycles, or when the onset of her menses (called menarche) is delayed past age 18. This type of amenorrhea is quite uncommon. It is often associated with an underlying medical condition, such as a pituitary tumor, or reproductive abnormalities that merit consultation and treatment with a specialist.
Secondary amenorrhea describes the situation when a woman who previously menstruated on a regular basis misses her periods for six months, or when a woman who previously experienced irregular periods skips her periods for 12 months. The cause of secondary amenorrhea is usually very high or very low levels of estrogen and a corresponding lack of ovulation (anovulation). Polycystic ovarian syndrome (PCOS), a hormonal imbalance related to insulin resistance, can cause months of amenorrhea followed by extremely heavy bleeding (menorrhagia) due to excessively high estrogen levels.
The most common form of amenorrhea is hypothalamic amenorrhea, where the female body reverts to survival mode because it cannot sustain reproductive mode. This condition develops when poor nutrition or stress alters your signaling to the brain to regulate the menstrual cycle. Women with this condition may be severely restricting their caloric intake, exercising more than two to three hours a day, or under major psychological stress. It is a common pattern seen in performance athletes and dancers, for example, as well as women with anorexia nervosa. In this situation your brain doesn’t get adequate energy or macronutrients to pulse the hormones that govern follicle ripening and release of eggs. This is one of the common causes of anovulation that responds well to natural treatments for amenorrhea.
Certain forms of birth control pills and IUD’s (like Mirena) can also cause absence or a noticeable decrease in menstrual flow. Such an effect is worth mentioning to your care provider, but it is common and of a different nature from infrequent, spotty or skipped periods for no known cause. Generally, as long as your flow is cyclic — whatever pattern it takes — it is considered regular and not particularly worrisome.
In some cases, amenorrhea is a symptom of hormonal imbalance due to perimenopause or insulin resistance (as in the case of PCOS). In this case, using progesterone support can sometimes help jump-start your body back to regular cycling. Remember, though, that unless you are pregnant, nursing, or experiencing other serious health concerns, menopause is officially announced by a complete lack of periods for 12 consecutive months.
In essence, amenorrhea can be viewed as a signal of underlying hormonal imbalance and should be taken seriously. In the long term it can lead to more significant, even irreversible health conditions, such as osteoporosis. But now that we’ve touched on some of the implications of amenorrhea, you may be wondering how to reverse it.
Examining your lifestyle for unusual stress factors, including extreme diet and exercise habits, is the first step to take in identifying the causes of missed periods. Talk to your healthcare practitioner and get a pelvic exam to rule out any abnormalities. You may also want to request a hormone panel to test your GnRH, FSH, LH, estrogen, and prolactin levels. And by all means, we encourage you to seek counseling if you feel there are psychological issues underpinning your amenorrhea. We’ve seen many patients’ cycles normalize just by optimizing their nutrition, reducing physical stress, and clearing up emotional blocks. Chances are, yours will, too.
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