WHERE’S MY PERIOD?

“It is very important that you develop a close, trusting relationship with your gynecologist and on the same token, that your gynecologist takes the time to listen and explain all these complicated issues to you during your office visits.” PERIOD

Amenorrhea is the fancy medical term for “absence of menstrual periods.” This can be either “primary” or “secondary.”  Primary amenorrhea means that a woman has not had her first period by the age of 15.  Secondary amenorrhea is when a woman who has had previous menstrual periods, all of a sudden does not get them for more than three to six months.  There are several causes for this, and we’ll touch up on this a bit later.

WHAT CAUSES THESE IRREGULAR PERIODS?

The endocrine system in the body, the system that controls all the hormone secretion, is very tightly regulated, and in. The case of menstruation, this system is made up of some very important players:  the brain, the ovaries, and the. Uterus. The hypothalamus makes a hormone called Gonadotropin Releasing Hormone (GnRH).   The ovaries on the other hand produce estrogen, progesterone, and testosterone.  Anything that affects any of the components of this system can lead to problems with your menstruation.

WHAT ARE SOME OF THE CAUSES OF THESE TWO TYPES OF AMENORRHEA?

Although not as common, a genetic or spontaneous abnormality may occur in the development of any of the involved reproductive. Organs, such as the ovaries or uterus, and lead to primary amenorrhea.  For example, a woman can be born without a uterus yet still have all external features of being a woman.  But for most women who don’t see a period by the age of 15, the delay is usually in the. Hormone production, and eventually do get a period without any intervention.

Secondary amenorrhea on the other hand is a more common condition and there are several aspects that can lead to. This condition.  Pregnancy is the most common cause of secondary amenorrhea. 

Patients

This can happen in patients with eating disorders like bulimia and anorexia, have low body weight or  body fat content. Or with emotional stress.  Certain tumors in the pituitary gland such as prolactinomas (tumors that secrete the hormone prolactin), can also lead to secondary. Amenorrhea.  There are certain common diseases such as Polycystic Ovarian Syndrome (PCOS) that cause irregular ovulation in a woman, and this. Can lead to abnormalities in their menstrual periods as well.  This is a common topic these days in my office so look out for an upcoming article I will write. On PCOS.

HOW WILL YOUR GYNECOLOGIST EVALUATE IRREGULAR MENSTRUAL PERIODS?

One of the most important aspects of this evaluation is the history and physical exam.  A carefully obtained detailed history may shed important clues about the cause of amenorrhea.  These include family history of abnormal menstrual periods, presence of any developmental problems during childhood, age at first period (called menarche), and frequency of menstrual periods since the onset of menstruation. 

Gynecologist

Other important questions that your gynecologist should ask is if there is any history of facial or chest hair, problems with your vision, headaches, adult acne, nipple discharge, etc.  Other relevant questions have to do with any medications you may be taking, recent gynecologic procedures such as dilation and curettage (D & C), recent illnesses or stressors, and significant changes in weight.  Any change in the intensity or frequency of exercise is also very important.   The physical examination is of great importance as well, and your gynecologist will not only perform a pelvic examination, but will also examine your face, neck and breasts looking for clues that may explain your changes in menstruation.

Laboratory or blood work is also an important part of the investigative process, and this will most likely include blood tests looking for hormone levels.  One of the most important lab tests is a pregnancy test, as this is the most common cause of secondary amenorrhea. 

HOW DO WE TREAT IRREGULAR MENSTRUAL PERIODS?

The goal of any treatment is to correct what’s causing the condition in the first place.

It is very important that you develop a close, trusting relationship with your gynecologist and on the same token, that your gynecologist takes the time to listen and explain all these complicated issues to you during your office visits.

Irregular menstrual periods in women with hypothalamic amenorrhea are sometimes normalized by simply making certain lifestyle modifications such as lowering the intensity and frequency of exercise, increasing the caloric intake in their diets, and reducing stress.  It is known that women who burn more calories than they consume can develop secondary amenorrhea.   In addition, all women with amenorrhea should pay close attention to their calcium and vitamin D intake.  They should take 1200 to 1500 mg of calcium each day along with 400 units of Vitamin D.

Unfortunately there is one problem that cannot be cured, and that is Menopause.  Menopause is when the ovary stops ovulating as part of the aging process and subsequently, periods stop.  By then, women are glad not to have to deal with periods anymore, but it does bring on a list of other potential ailments.  Stay tuned for my article on Menopause and Hormone Replacement Therapy.

For the rest of you out there with normal monthly periods, be thankful for them as they are a sign of good health!

By CHRISTINA PEÑA, M.D.