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Stopping menstruation - when the reason is not pregnancy


Amenorrhea is most often interpreted as a sure sign of pregnancy. Of course, in most cases this is true. However, it should be remembered that there are many other conditions that can also lead to the absence of menstruation by the expected date (statistics say that this problem affects about 3 to 4% of non-pregnant women). So, how to interpret period retention correctly and when to go to a gynecologist because of it?

Primary and secondary amenorrhea

There are so-called primary and secondary amenorrhea. The first applies only to girls who are 16 years old and have not yet had their first menstrual period.

When it comes to secondary amenorrhea, it is defined as 3- (when previous cycles were regular) or 6-month (when previous cycles were irregular) amenorrhea in women who have already menstruated.

Secondary amenorrhea - the most common causes

As we mentioned at the beginning, the most common cause of secondary amenorrhea is pregnancy. Other conditions that can also lead to it include:

  • Hypothalamic hormonal disorders - conditions such as stress, rapid weight loss or large, prolonged physical exertion (this applies especially to women practicing sports) can lead to disturbances in the functioning of the hypothalamic-pituitary-gonadal axis (the so-called sex axis), which in turn will result stopping the menstrual cycle and no bleeding.
  • hyperprolactinemia - prolactin is a very important hormone produced by the pituitary gland, but its excess can be associated with many negative health consequences (mainly due to inhibition of the aforementioned sexual axis). Of these, menstrual disorders, infertility, acne, excessive development of male hair, decreased libido and galactorrhoea come to the fore.
  • Polycystic ovary syndrome (PCOS) - is one of the most common endocrine disorders in women of reproductive age (it is estimated that about 10 to 15% of the female population suffers from PCOS). It is characterized by varying degrees of menstrual disorders (up to and including amenorrhea), infertility (the most common cause of pregnancy problems in our country), obesity, insulin resistance and hyperadrogenism (it is mainly manifested by excessive development of male hair, acne and significant greasy skin) .
  • Hyperthyroidism and hypothyroidism - any thyroid disorders may be manifested as menstrual disorders and significant problems with pregnancy and its maintenance (hypothyroidism is particularly dangerous here).
  • Premature ovarian failure - a disorder in which the ovaries lose their function before the woman is 40 years old. Clinically, this is manifested by premature menopause and thus inhibition of the period.
  • Asherman's syndrome - it is a complication of a procedure to cure the uterine cavity (may also occur after Caesarean section) and manifests itself in the absence or very scanty periods, painful bleeding, habitual miscarriages and infertility.

Secondary amenorrhea - when to go to a gynecologist?

Secondary amenorrhea is always a disturbing symptom and regardless of whether a woman suspects that she is pregnant or not should prompt her to visit a gynecologist. After a thorough examination of the patient and a number of laboratory tests, the doctor will be able to make a diagnosis and recommend her further action, which will depend on the reason for stopping menstruation.

Secondary amenorrhea - treatment?

Treatment of secondary amenorrhea is complex and consists of non-pharmacological management (a healthy, balanced diet covering caloric as well as mineral and vitamin needs, avoiding stress and avoiding excessive physical exertion), pharmacological (e.g. pharmacological reduction of prolactin levels) and surgical (necessary among others in Asherman's syndrome). At this point it is worth emphasizing that this therapy requires close cooperation between the doctor and patient and is often long-lasting.

To sum up, although pregnancy is usually associated with secondary amenorrhea, this symptom should never be underestimated. In some cases, it may have a dangerous pathology that requires treatment.

Bibliography:Obstetrics and gynecology by Grzegorz H. BręborowiczJohns Hopkins Gynecology and Obstetrics Handbook