Causes of Amenorrhoea

Amenorrhoea may be a state of affairs that is present up to a given point of time. The girl has never menstruated, even though most of her contemporaries commenced in the traditional 10 – 16 year segment. Doctors call this primary amenorrhoea. There are various causes, most of which are uncommon.

Some girls are born with an imperforate hymen. This means the thin membrane that often partially covers the vaginal opening does not contain any opening in it. When menstruation occurs, the blood becomes dammed up in the vagina behind the hymen, and is not allowed to escape, due to the mechanical barrier. An examination by the doctor will reveal a bluish, bulging hymen with no point of entry. Fortunately, the simple expedient of making an incision will be followed by the escape of the dammed-up blood, and menstruation may proceed normally after this.

On rarer occasions, some females are born with a congenital absence of the vagina. This may be associated with other congenital developmental problems, most likely in the urinary tract. Plastic surgery can assist these women regain a greater degree of normal reconstruction.

Others may be afflicted with chromosomal abnormalities. In place of the usual two XX female chromosomes there is only one, and there may be poor or deficient secondary sexual development.

Diagnosis is a specialized procedure; chromosomal analyses are carried out, and if deficiency exists, hormonal therapy can yield very good results.

In other women, menstrual periods may suddenly cease, even though they may have been relatively normal up till that time. This is termed secondary amenorrhoea.

The most common cause is a purely normal and physiological one, and is due to pregnancy. Sudden cessation of normal menstrual periods in a woman enjoying regular intercourse and not taking any contraceptive action is usually considered due to pregnancy until proved otherwise. Today, with rapid and accurate radioimmunoassay tests for pregnancy identification, a diagnosis can often be made before the first missed period! Certainly they can give a positive answer within a day or two of conception.

Another fairly common cause for missed periods is the person’s age. During the first two to three years following the menarche (the start of menstruation) it is common for young women to miss a period here and there, or to miss several consecutively. This is merely due to a fairly low level of hormones in the system and usually corrects itself without any treatment. Of course, this can often lead to much heartburning (the mental kind) and anguish, especially if the young lady has been “playing around,” as they say.

The contraceptive pill is notorious for producing period disorders. Those who regularly take the pill have a complete inhibition of ovulation. This means that the egg is not released from the ovary each menstrual month. The pill is usually taken for 21 consecutive days, and then discontinued for the next seven days.

During this break, an artificial menstruation or more correctly withdrawal bleeding, commonly occurs, but to a limited extent. It may last for only an hour or so or half a day. In some, there is no bleeding at all, and this situation may persist indefinitely. More serious, however, is what occurs when the pill is stopped, and a return to normal fertility is desired.

In a certain proportion of women, post-pill amenorrhoea occurs. This means that the ovary fails to produce the egg each month. This can persist for several months or even up to several years. It is a most frustrating situation, particularly in the case of young marrieds who had hoped to plan their family in an intelligent manner, only to find that when they wanted to reproduce, this was denied to them. It is food for thought for those contemplating this sort of thing. Fortunately today with modern treatment, this can be rectified.

Other reasons also exist. It seems that they are mediated via the higher centers in the brain, and this produces a temporary shutdown of the hormone-stimulating mechanism that prods the ovaries into action. For, without activity in the ovaries, if an egg is not released, then menstruation simply cannot follow. Crash diets in young women provide a well-known cause. Sometimes this has led to the more problematical condition of anorexia nervosa, in which failure to eat is tied in with emotional crises, major weight loss and ill health. Other severe emotional strains are well documented for interfering with regular menstrual functioning. Sometimes, in rare situations, the ovary just prematurely ceases to operate.

Women engaging in sport, strenuous athletics, vigorous exercises, and those who do ballet training (where a strict diet, thin figure and a great deal of physical activity is involved) often do not menstruate. Hormonal checking indicates a low level of female hormone and an increased amount of male hormone in their system, all of which tend to reduce the chance of regular ovulation and normal periods. Generally, when these women cease these activities later on, they quickly return to normal, and periods often start automatically.

All of these situations require the attention of the doctor. They are not amenable to self-treatment, and the sooner a visit to your own understanding physician or gynecologist is made for full examination and appraisal, the better. Be guided by the advice of the expert in these matters. Psychologically, the sooner a move for a proper diagnosis is made, the better.