Amenorrhea

Amenorrhoea is when a woman of reproductive age (14-49 years) does not have her monthly menstrual periods. This may sometimes happen under normal conditions in certain groups of women like young girls, pregnant women, breastfeeding women and women who have reached menopause. However, if you do not start menstruating between the ages of 14-16 or when your menstrual periods stop for some months, you should visit your healthcare provider to know what the cause may be.

Although the most significant symptom here is the lack of periods, you may also notice that you:

• Feel hot flushes (internal heat).
• Have a milky liquid coming out from your nipple.
• Speak with a deeper voice than usual.
• Notice hair in odd places like your chin and your back.
• Have pimples (acne).
• Feel pain in your stomach around your normal circle period.
• Have an abnormally dry vagina or low sexual drive.

The most typical cause of missed or absent periods is pregnancy. Others include:

• Stress.
• Menopause (usually seen in women older than 45 years who haven't seen their periods in 12 months).
• Genetic conditions like Turners syndrome.
• Eating disorders.
• Hormonal problems such as polycystic ovarian syndrome (PCOS).
• Brain tumours.
• Thyroid diseases or other hormonal diseases.
• Being under or overweight.
• Conditions that block your vagina.
• Following surgeries to remove the ovary or uterus.
• Illnesses that causes rapid weight loss like diabetes or cancers.

The following things can put you at risk of delayed or absent menstrual periods:

• Athletics or exercising too much.
• Late or irregular periods in your mother or sister.
• Malnutrition or poor diet.
• Side effects of medications like morphine, cocaine and tramadol.
• Use of birth control pills or injections.
• Heavy bleeding following childbirth.
• Infections like meningitis, tuberculosis and syphilis.

It is essential to take every child older than 16years who hasn't had her menstrual period to a hospital. If you yourself haven't seen your period in 3 months (or 6 months if your cycle is irregular), you should also visit the hospital.

There may also be additional reasons to visit your healthcare provider including:

• Absence of breast development, pubic hair growth or other signs of puberty in a child older than 14.
• Deep voice.
• Hair growth on the chin, back or other unusual parts of the body.
• Vision changes, loss of hearing and frequent headaches.
• Presence of genitals that do not appear clearly female or male.

The following are ways to ensure your period comes on time every month:

• Eat well and maintain a healthy weight. Include fruits and vegetables in your diet.
• Do not attempt rapid or extreme weight loss.
• Drink water and keep yourself hydrated.
• Avoid risk factors such as unprotected sexual intercourse.
• Track your periods so you can notice delays early. The duration of your cycle is the number of days between the first day of your last period (the first day you saw blood) to the first day of the next period. You can use smartphone applications and calendars to do this.

Self-care tips

The following are things you can do if you do not see your monthly period:

• Track your cycle. Confirm if your dates are correct and how long ago you were supposed to have your period. Also, confirm how long your periods usually last and what age you started having them.
• Take note of any new medications or diets that you may have recently started.
• Eat well, do not try to lose weight too fast.
• Maintain a healthy exercise routine, avoid strenuous or excessive exercising.
• You can do at home pregnancy tests using the urine strip if you suspect pregnancy.

Treatment options

The treatments recommended by your healthcare provider depends on the specific cause of amenorrhoea. The following treatments may be of help:

• Hormone medications that contain oestrogen or progesterone to regulate your cycle.
• Antenatal care for when you are pregnant.
• Thyroid hormone or anti-thyroid drugs as needed for people with thyroid disease.
• Bromocriptine and similar drugs treat milky nipple discharge.
• People with eating disorders and those with genetic disorders or unclear genitals may benefit from psychotherapy.
• Your healthcare provider can also treat tumours, goitre, obstruction and some other causes surgically.

A missed period can cause anxiety and concern for many women because of the many possible causes. You should always exclude pregnancy as a cause before looking for other reasons. Early identification and assessment can help treat the cause and also reassure you. In rare cases, it can be permanent, your periods may never come back. However, the majority of the causes of missed periods are mild and are easily treatable. Reach out to your healthcare provider as soon as possible. A healthy lifestyle of a balanced diet and exercise can help maintain healthy menstrual cycles.