What is amenorrhea?
Amenorrhea is the absence of periods (menstrual bleeding) for more than 6 months. Absence of periods during 2-6 months called oligomenorrhea. Amenorrhea could be primary or secondary.
 Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in girls by age 14-15 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in girls by age 16-17 years.
Secondary amenorrhea is the absence of periods in girls and women who had been menstruating but later stop menstruating for 6 or more months.
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AMENORRHEA in Adolescence
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Adolescence is a very special period of the reproductive system of girls – adolescence is the period between puberty and adulthood. During this period of time several hormonal changes occurs in girl’s body which is necessary for the start of the menstrual cycles. This period of development depends on a number of different things including genetics, constitution, nutrition and general health status. During puberty ovaries start producing sex hormones (mainly estrogens) that cause body changes and the development of secondary sex characteristics. The body of healthy girl needs some period for sex hormones to reach the needed concentration before starting regular menstruations - it may take a while for ovulation to occur regularly. So the period of time between puberty and first menstruation is a period of normal amenorrhea and this period could be considered as a “normal cause of amenorrhea”.
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AMENORRHEA during Pregnancy
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It is well known that missed period is the first symptom for possible pregnancy. In general women menstruate regularly every month only if ovulated ovum is not fertilized and missed period could be the first signal of fertilization and implantation.
So, pregnancy is a normal cause for amenorrhea. Actually amenorrhea is necessary for normal baby development in the uterus.
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AMENORRHEA during Breastfeeding
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When healthy women breastfeed after delivery, menstruation usually stops which is absolutely normal – it is happening because of dramatic hormonal changes needed for normal lactation and after-delivery rehabilitation. Breastfeeding women usually don’t ovulate and don’t menstruate. So, breastfeeding is a normal cause for amenorrhea.
At the same time some non-menstrual bleeding or spotting could occur during breastfeeding period - usually within two months after delivery. Even while they are still nursing, most breastfeeding women could resume menstruation after 6-8 months. In general, the more intensively a baby is breastfed, the later regular menstrual periods resume.
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AMENORRHEA and Hormonal Contraception or Hormonal Treatment
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Some types of hormonal contraception could be the reason for temporary amenorrhea. For example, amenorrhea can occur from hormonal contraception called Depo-Provera (medroxyprogesterone). Amenorrhea can occur even months after discontinuing Depo-Provera.
Sometimes Birth Control Pills can be a cause of amenorrhea (as a side effect or because of wrong use). If Birth Control Pills are used for postponing periods and cutting periods for several months, it also could be considered as a normal cause for amenorrhea.
Extended-cycle oral contraception also could be a reason for amenorrhea. Ethinyl estradiol and levonorgestrel (Brand Names: Jolessa, Quasense, Seasonale, Seasonique) can be used as extended-cycle oral contraception. These extended-cycle contraceptives contain a combination of female hormones that prevent ovulation and normal regular menstruation causing hormonal amenorrhea.
Some hormonal implants also could develop the amenorrhea due hormonal changes and anovulation (absence of ovulation).
There are several health conditions including infertility when doctors use several hormonal drugs for treatment and/or ovulation induction and amenorrhea could be as a result of needed treatment and/or as a side effect from treatments.
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AMENORRHEA during PERIMENOPAUSE and MENOPAUSE
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Perimenopause is a naturally occurring transition period of women life which is happening before menopause - it is the time when your body begins its transition into menopause. Perimenopause is the stage of women’s reproductive life that begins several years before menopause, when the ovaries gradually begin to produce less estrogens. It usually starts in women’s 40s, but can start in women’s 30s. The main symptom of perimenopause could be amenorrhea.
Menopause is a naturally occurring stage in women life which means the cessation of menstrual periods – it is a time of the end of women’s reproductive function and reproductive years. Medically menopause is defined as the absence of menstrual periods for 12 consecutive months (natural amenorrhea). Usually menopause happens between the ages of 45 and 55. During menopause, a women’s reproductive system changes, resulting in a discontinuation of estrogen production, the menstrual cycle and egg maturation – main causes of amenorrhea during menopause.
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