Amenorrhea and infertility

When you miss your period, the doctor calls this condition amenorrhea. Since there are many possible reasons for this symptom, your doctor will have to do a detailed evaluation to come to the right diagnosis.

Amenorrhea is the medical term which is used to describe the absence of periods . Remember that amenorrhea itself is not a disease, but is usually a symptom of another condition. Depending on the reason, you might experience other symptoms, such as headache, vision changes, milky nipple discharge, hair loss, or excess facial hair.

Doctors classify amenorrhea as being either physiologic or pathologic (abnormal) . Women normally do not menstruate before puberty, during pregnancy, and after menopause - these are the physiological causes of amenorrhea. However, if a woman does not get her period when she normally should, it may be the symptom of a medical condition.

There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea. Primary amenorrhea is when a young woman has not had her first period by the age of 16. Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period for three or more months.

What Causes Amenorrhea?

Amenorrhea can be caused by anything which affects the normal functioning of the organs and hormones involved in menstruation. Since menstruation is such a complex process, it's not surprising that a large number of conditions could cause amenorrhea.

Possible causes of primary amenorrhea (when a woman never gets her first period) include:

  • Failure of the ovaries . This is called POF, or premature ovarian failure.
  • Problems in the central nervous system (brain ) or the pituitary gland , which cause hypogonadotropic hypogonadism
  • Absent uterus (Mullerian agenesis)

Common causes of secondary amenorrhea (when a woman who has had normal periods stops getting them) include:

It's a long list, but remember that the commonest reason for missing a period in infertile women is anovulation.

The list of causes looks very intimidating; and you may be completely confused as to what the possible diagnosis in your case is. However, let me try to simplify this, so it's easier for you to make sense of what the doctor will do. Let's start with the basics. In order to get a period, you basically need just two things:

1. a uterus, which sheds its uterine lining as a period
2. hormones ( estrogen and progesterone) which act on the uterine lining, and cause it to shed

If you miss a period, this means there are only 2 broad possibilities.

1. There's a problem with the uterus. Thus, is may be damaged ( because of intrauterine adhesions)

2. There's a problem with the reproductive hormones . Their levels may be too low; or too high; or out of balance !

The first test the doctor may do is a vaginal ultrasound scan to check your uterus; and your uterine lining. If this is normal, then it's likely the problem is with your hormones.

Sometimes, the doctor may give you hormones as a therapeutic trial to see if this can induce your period. This is called a progesterone challenge test; and consists of 5 days of 20 mg medroxyprogesterone daily. Thus, if you get your periods after taking progesterone, this means your uterus is fine; that you have high estrogen levels; and that you are not producing progesterone on your own (this is the picture classically found in women with PCOD).

If you do not get your periods after taking the progesterone, this means either that your uterus is damaged; or that you are not producing enough estrogen. The other possibilities include: pregnancy; and the possibility of a functional ovarian cyst ( which can produce estrogen and progesterone and delay the period)

If you miss your periods, your doctor will have to run tests in order to find out what the problem is. If you keep an accurate menstrual diary, this will help the doctor in making the right diagnosis. When was your last period? Was it normal? What were your periods like before this? You can read more about the sequence of tests needed (and the medicines he may have to use to induce a period) at Click here

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.