Amenorrhea is the absence of the monthly menstrual period. Missed periods in the reproductive age are usually a symptom of an underlying health problem and therefore should not be ignored unless you are pregnant or have reached menopause. Amenorrhea is of two types. Primary amenorrhea is when a female has not had her first period, or menarche, by the age of 16. Secondary amenorrhea is the absence of menstrual periods for six months in a woman who previously had a normal menstrual cycle.

What causes Amenorrhea?

A woman’s period is controlled by the hypothalamus and the pituitary gland located in the brain. The pituitary gland makes hormones that activate the production of the hormones estrogen and progesterone by the ovaries. These hormones play a vital role in inducing menstruation. They make the lining of the uterus thicker to prepare your body for pregnancy and if pregnancy does not occur, hormone levels drop and the uterus sheds the thickened lining which is expelled from the body as menstrual discharge. Hormonal imbalance –very low or very high levels of estrogen and progesterone– is often the cause of missed periods. A number of medical conditions can disturb hormonal levels in a woman’s body, causing irregularities in the monthly cycle:

  • Anovulation – no ovulation or release of egg by the ovaries for three months or more
  • Hormonal imbalance caused by malfunction of the pituitary gland
  • Premature ovarian failure – when a woman’s ovaries stop working before she turns 40
  • Athletic amenorrhea– when excessive exercise leads to drop in estrogen levels
  • Hyperandrogenaemia – high levels of male sex hormones in the body
  • Polycystic ovaries (PCOD) (Add link to blog 12 – I have PCOD can I still conceive)
  • Premature menopause
  • Excessive stress
  • Nutritional deficiencies
  • Excessive weight loss or weight gain
  • Prolonged usage of birth control pills leading to anovulation
  • Thyroid disorders
  • Hyperprolactinaemia – high levels of breastfeeding hormone prolactin due to malfunction of the pituitary gland
  • Asherman syndrome – formation of scar tissue in the uterus after uterine surgery
  • Congenital defect such as absence of uterus
  • Side effect of some medicines

To identify the cause of amenorrhea, your doctor would do an ultrasound scan to check the health of your uterus and ovaries along with blood tests to check your hormone levels.

Can a woman with amenorrhea conceive naturally?

A woman can get pregnant naturally only if she is ovulating. If you are missing your periods consistently it is most likely that you are not ovulating, and therefore cannot get pregnant without medical assistance. If you’ve missed your periods for more than three months, see a fertility doctor at the earliest so that they can do a timely diagnosis and initiate appropriate treatment.

In treating amenorrhea-related infertility your doctor’s primary goal would be to try and restore your natural menstrual cycle. Treatment would depend on the cause of amenorrhea – for example, if hormonal imbalance is the underlying cause, hormone therapy may be given to normalize your hormone levels. If too much exercise has caused the problem, your doctor may just advise you to change your lifestyle and no medication may be given.

If your fertility doctor finds that polycystic ovaries (PCOD) or premature ovarian failure is behind the problem, they would need to do further investigations based on the results of which they can initiate infertility treatment.

To summarize, amenorrhea can make getting pregnant difficult but not impossible.

A woman who is having irregular periods can try to conceive naturally for a couple of months; however she may find it difficult it as she has no way to know if she has ovulated in a particular month and which are her most fertile days. Also, the problem of hormonal imbalance can worsen with time and lead to further health problems such as osteoporosis. Therefore, it would be wise to consult a fertility doctor who can evaluate your condition and help restore your ovulation cycle to help you conceive as naturally as possible.