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The menstrual cycle is of immense importance and a regular cycle indicates the well-being of the underlying hormonal system. Missing a period when not pregnant or breastfeeding is a sign that there is something wrong that needs attending to.

The absence of periods is called as amenorrhea and it is classified into two types. The first or primary type of amenorrhea is one where a girl never gets a period even after hitting puberty. The other or the secondary type of amenorrhea is when regular periods stop for more than three months.  

Causes Of amenorrhea

Primary Amenorrhea

  • Developmental disorders where the female sex organs (ovaries) do not develop
  • Problems originating from the pituitary gland, the master gland from where the hormones responsible for the normal functioning of the menstrual cycle are released.
  • Disorders of the brain or spinal cord
  • Structural abnormality of the vagina
  • Uterine scarring

Secondary Amenorrhea

A number of conditions can result in the cessation of the menstrual cycle including natural ones like getting pregnant and breastfeeding. Some of the conditions that cause an unexpected interruption of the menstrual cycle are:

  • Polycystic Ovary syndrome, which causes a high sustained level of hormones in the body and does not allow the necessary fluctuation needed for the menstrual cycle to progress.
  • Tumors
  •  Stress
  • Increased exercise
  • Thyroid gland dysfunction
  • Certain medication like antidepressants, blood pressure medication and chemotherapy drugs.

Two of the main complications that are associated with amenorrhea are a loss of bone density and a difficulty in getting pregnant. There are certain conditions when getting pregnant is possible even in the absence of a regular menstrual cycle, however, others make that an impossibility.

The loss of bone density is associated with a decrease in the amount of estrogen being produced in the body. The levels of estrogen are closely linked with various phases of the menstrual cycle and it can work both ways.

The estrogen levels may be low because the menstrual cycle is not progressing as it should or low levels of estrogen can prevent the menstrual cycle from progressing. Affected individuals must be given calcium and vitamin D supplements to try and improve bone health.

Tests

Your doctor may order one or more of the following investigations in an attempt to pinpoint the primary cause of amenorrhea.  These include a test for pregnancy, a thyroid function test, a male hormone test, a prolactin test an ultrasound, a CT scan and an MRI.

Treatment

The eventual treatment for the condition will depend on the underlying cause that has been determined. For example, a thyroid hormone imbalance will need to be treated appropriately and the amenorrhea will resolve as the condition is brought under control.

The doctors may prescribe contraceptive pills and hormone therapy to see if the menstrual cycle can be "kickstarted" without any other intervention. Other changes to the lifestyle such as avoiding too much stress, balancing the amount of exercise being done and keeping your weight in check are also helpful in keeping a regular menstrual cycle.   

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