Amenorrhoea is when a woman does not have a regular menstrual cycle. There are various physiological reasons for this. During puberty the menstrual cycle is erratic because your hormones haven’t yet settled into a routine. It can also occur during pregnancy, while breastfeeding and during the perimenopause – the years leading up to the menopause, when the menstrual cycle changes due to falling oestrogen levels.
In medical terms it is categorised into two types: -
- Primary amenorrhoea – when a girl doesn’t start her period by the age of 14 or 16 if she has developed breasts and pubic hair. According to NHS Direct this affects around 3 in 1000 girls.
- Secondary amenorrhoea – this is when a woman has a menstrual cycle but has not had a period for six months. This affects 3% of women.
Causes of Amenorrhoea
Primary amenorrhoea can be hereditary so it’s helpful to find out what your mother’s periods were like and at what age she started menstruating. In rare cases it is caused by a closed hymen, which makes a monthly bleed impossible.
The most common cause of secondary amenorrhoea is pregnancy, which is the first thing you will be tested for. It can also be related to dietary and lifestyle factors – being overweight or underweight. You won’t have regular periods if your body mass index (BMI) is below 19. Your BMI is the measurement used by doctors to see if you are within a healthy weight range. You can work this out by dividing your weight (kg) by your height (m2), or by using an online calculator. Amenorrhoea is common in women who exercise professionally for a living. Excessive exercise and low body fat interrupts the body’s natural hormonal cycle.
Other factors that can affect the menstrual cycle include: -
- Stress.
- Long-term illness.
- Changing your contraceptive routine. It can take up to six months for your natural cycle to restart.
- Polycystic Ovarian Syndrome (PCOS) – this is when harmless cysts develop on the ovaries. It has been linked to high levels of male hormones in the body.
- A thyroid disorder. One indication of this is a sudden change in weight, tiredness and low energy levels.
- Hormonal malfunction – when the parts of the brain that stimulate ovulation and trigger menstruation aren’t working properly.
- After a hysterectomy a woman will no longer have periods.
Treatments for Amenorrhoea
Pregnancy is the most obvious cause of amenorrhoea so a test will be offered to rule this out. Treatment depends on the root cause. If you are in your forties hormone levels can be tested to see if you are perimenopausal. Be prepared for questions about diet and exercise, stress and lifestyle as these can all influence your cycle. If you are running on empty, not eating properly or eating foods that are stressing out your body you will need to make some changes. Maintain these changes for a few months to see if your cycle regulates itself. You may find it helpful to keep a diary to see what helps.
Tests can also be carried out to check whether your thyroid function is normal and whether you have PCOS.
HRT (hormone replacement therapy) can help correct hormonal imbalances in the body. It replaces missing oestrogen and gives you a ‘period’. However, it isn’t a quick fix, as you will need to commit to taking it for a minimum of three months to assess how effective it is. You may also need to try different doses and delivery methods to find the right one for you. The combined oral contraceptive pill does the same thing but the dose of oestrogen is much stronger, which can cause other side effects such as bloating, fluid retention, and mood swings.
Amenorrhoea can be resolved once the root cause is identified. You need to be committed to making some changes to your lifestyle to help your body regulate its hormones naturally. Foods containing phytoestrogens (natural plant oestrogens) have been widely studied for their impact in reducing menopausal symptoms, and can supply the body with valuable nutrients. Complementary therapies such as acupuncture and herbal medicine can also help regulate your cycle.
This article is for general information purposes only. Consult your health practitioner for specific guidance on a health issue.
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