A discussion of Secondary Amenorrhea.

>> Thursday, April 7, 2011

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"Dear KnowYourV, ,

I’m so worried. My husband and I have been trying to have a baby so I've been keeping very close track of my menstrual cycles & ovulation. Then, back in September, it just stopped and I have not had one since. I’m only 31 years old and I have always had really regular cycles to the point where I knew the day of the month and whether it would come morning or afternoon. My pregnancy tests have been negative. What do you think could be wrong with me? Aren't I too young for menopause?"

Wow, Mariann you sure do have regular cycles, I can understand why you are worried. This condition is called Secondary Amenorrhea. Amenorrhea is absence of menstrual cycles. Secondary Amenorrhea is when a woman who has been having normal monthly cycles stops for 6 or more months. A sign (not a disease), amenorrhea seldom results from a serious condition. However, not knowing why your cycle has stopped can be very stressful.

I should quickly mention Primary Amenorrhea as you may be wondering about it. PrimaryAmenorrhea is when a young women has not begun her menstruation by age 16. At this point a definite evaluation should be done to check for chromosomal abnormalities, imperforate hymen, absence of female sex organs, hormone dysfunctions and many things we can discuss at a later time.

Cycle stoppages due to breastfeeding, pregnancy or menopause are not considered Secondary Amenorrhea. Also, women taking the birth control pill or hormone shots like Depo-Provera may not have any monthly cycle and it may take 6 months or more for menstruation to return after stopping. But again, these are not Secondary Amenorrhea as they are known expected responses to those medications.

It is a concern when we see amenorrhea and there is no obvious cause but some common causes of Secondary Amenorrhea follow:

Stress can play a big factor is menstrual cycle changes and cause Secondary Amenorrhea. This happens because mental stress can temporarily alter the functioning of the hypothalamus, which is an area of the brain that controls the hormones that regulate your menstrual cycles. Ovulation and menstruation may stop as a result and return gradually as the stress reduces. I’m concerned that this is what is happening with you as you and your husband have been trying to have a baby which can be very stressful. It is not unusual to see women have difficulty getting pregnant, knowing both she and her partner are healthy.

Abnormally low body weight or body fat less than 15-17% that is induced by over-exercising or an eating disorder can disrupt many hormone functions ultimately interfering with ovulation and menstruation. It is seen in athletes and also with women with anorexia and other eating disorders. If a woman is normally extremely thin by genetic design, it seems to have no affect on her ovulation or menstruation.

Hormone Imbalances can always be a cause of menstrual irregularities. The most common hormone imbalance in young women in the U.S. is PCOS (polycystic ovarian syndrome). We have discussed this previously. Women who suffer from this have high levels of estrogen & androgens which cause them to have this problem. PCOS also causes irregular cycles, anovulation (no ovulation), high insulin & blood sugar levels, abnormal hair growth on face & chest. These can be corrected with medications.

Thyroid malfunction, pituitary tumor and primary ovarian insufficiency are all causes for Secondary Amenorrhea and need to be diagnosed by blood tests. When the thyroid is not functioning properly it can affect the hypothalamus, which in turn can cause menstrual irregularities. This is true for the pituitary gland as well. When the pituitary grows a small benign tumor called a prolactinoma it stimulates the gland to produce excess hormone called prolactin which in turn stimulates the breast to produce milk. Prolactin also has an affect on ovulation and menstruation, which can cause irregular cycles and amenorrhea.

Ovarian failure or menopause usually happens around age 45-55. However, some women lose their reserves of eggs and follicles much sooner (as young as 28).

Uterine Scarring or Asherma’s syndrome is when the inside of the uterus builds up with so much scar tissue from previous uterine surgeries like D & C for miscarriage or abortions, cesarean sections, myomectomies (removal of uterine fibroids) or severe pelvic infection. This scarring prevents the normal build up and shedding of the uterine lining.

So, that should give you much to think about. It’s so important to know what can affect your body so that you can talk with your doctor and get appropriate treatment.
Also, remember also that when you are going through all these changes, it can affect your discharge and you may notice different feminine odors that may bother you. Stress is so hard on our bodies! I have so many patients that have gotten the WaterWorks system and are so relieved to have a natural way to cleanse the vagina on a daily basis. No more pills, vaginal gels, or harsh chemicals. How awesome to have something that works to help feel clean and fresh and not have to deal with the lingering odor. It uses only tap water and it’s FDA cleared so you know it’s tested as a safe product. And it's reusable; so that saves money.

Stay well this week. Eat healthy food, drink lots of water, make sure to take adequate Vitamin D3, & C intake and get plenty of rest.
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