What is Amenorrhea?

Hi all!

If you’ve followed along on my Instagram, you’ve probably heard me talk about amenorrhea before, but some of you may not have a great understanding of what it is or why it happens.

In a nutshell, amenorrhea refers to having no menstrual cycle. Primary amenorrhea means you never had one (typically by the age of 16), but secondary amenorrhea (which is usually what I am referring to) means you previously had a normal menstrual cycle but it has stopped. Most doctors will consider it an issue if you miss periods for 3-6 months consistently, depending on your previous history. This excludes pregnancy and breastfeeding, when it is normal to have no period.

There are a few reasons for secondary amenorrhea might occur, but the ones I see most often are PCOS, being underweight/having restrictive eating habits, and post-pill amenorrhea, which doesn’t always have a clear etiology.

PCOS (Polycystic Ovarian Syndrome) is a condition in which individuals typically exhibit high testosterone, insulin resistance, and cysts on their ovaries. You may not have all three symptoms for a diagnosis, sometimes only two exist. There is not a clear reason why this happens to some people, though it is often hereditary and many doctors think that insulin resistance/hyper insulinemia are the root causes of the condition. You may have excess insulin output without showing signs of insulin resistance, so generally an insulin test is a good idea in trying to diagnose PCOS.

The other two conditions are both considered hypothalamic amenorrhea, meaning your brain is not sending a signal to your body to ovulate. In women who suffer from disordered eating or low body fat (this can happen to women prepping for bikini competitions, for example), the body simply does not have enough body fat to be making hormones appropriately, and most non-essential functions are shut down to save energy when someone is taking in too little. The body also interprets this as a time of famine, which would not be an ideal time to reproduce.

When it comes to post-pill amenorrhea, the root is still in the hypothalamus – the brain has been shut down for so long due to birth control that it does not kick back into gear easily in some women. This can be a little more complicated to diagnose, especially since most doctors do not like to say the pill has negative side effects.

While it may seem nice to not have a period, there are many negative side effects to lack of menstruation that get worse as time goes on. If you have not had a period for 6 months consistently, I urge you to get a bone scan (*unless this is PCOS related), as many individuals start to see bone loss in as little as 6 months with hypothalamic amenorrhea.

The treatment will depend on the type of amenorrhea you have, but diet and exercise play a HUGE ROLE in healing your hormones regardless of the root. If you’re suffering from amenorrhea, please see a doctor, and reach out to a professional (like me!) for help.