In part 1 and part 2 of this 3-part series, we covered the causes of amenorrhea, which is defined as lack of menstruation for three or more months in previously regularly cycling women, or for six months in women whose cycles were previously irregular. Recall that amenorrhea is classified as primary (you never started having periods) or secondary (you used to have periods and now you don’t). But what are the possible health effects of not having your period for a prolonged period of time? What can you do if your period has stopped, and what type of diagnostic workup can you expect? What treatment options exist for amenorrhea? In other words, how do you “fix” amenorrhea?
What are the possible negative health effects of amenorrhea?
A 2023 article from the online medical reference Merck Manual explains that in women who don’t have a period for a prolonged amount of time outside the expected and normal contexts of pregnancy, breastfeeding, or menopause, and aren’t artificially inducing menstrual suppression with hormonal birth control, amenorrhea “may be the first symptom of a serious disorder,” such as a reproductive birth defect or genetic disorder. Women who are amenorrheic are almost certainly not ovulating, meaning that they are missing out on the health benefits we covered in our Reasons Women Need Periods series. Amenorrhea also translates to an inability to get pregnant naturally. Women who don’t have periods for a long time because of a medical cause also “may develop masculine characteristics (virilization), such as excess body hair (hirsutism), a deepened voice, and increased muscle size” and “may have headaches, vision problems, or a decreased sex drive.”
Over time, amenorrheic women may also experience symptoms or problems otherwise particular to menopause, due to an estrogen deficiency. These may include “hot flashes, vaginal dryness, decreased bone density (osteoporosis), and an increased risk of heart and blood vessel disorders.” These women may also be at increased risk of developing endometrial cancer, because “without a monthly bleed, the lining of the womb can thicken, which, over time, could encourage abnormal cells to develop and lead to endometrial cancer.”
What can you do if your period has stopped?
Primary amenorrhea treatment requires medical attention
What you can do about amenorrhea depends on what caused it in the first place. Primary amenorrhea occurs in teenage girls who don’t go through puberty by age 13, or don’t get their period within 3 years of their breasts developing, or don’t start their periods by age 15. Genetic disorders or reproductive birth defects that either physically block the outflow of menstrual blood or even prevent the development of the uterus or other reproductive organs altogether are the most likely culprits—though these are relatively rare—behind primary amenorrhea. Certainly, these things are outside the control of a parent to fix, and consulting a healthcare provider will be necessary.
Secondary amenorrhea might be fixable by addressing lifestyle factors
If you’re experiencing secondary amenorrhea, meaning that you used to have periods and they’ve stopped for the time frame above that applies to you (which depends on whether you were regularly cycling or not to begin with), first consider whether lifestyle factors, many of which may be within your control, might be at play.
Weight, exercise, and nutrition factors
Being obese or underweight or suffering from an eating disorder can shut down your cycle, as can overexercise (yes, even if you are a normal weight). If you’re on either end of the weight spectrum or struggling with an eating disorder, seek help from a registered dietitian along with your doctor, functional medicine provider, therapist, and/or other primary care provider to make a plan to achieve a healthy weight. If overexercise is your issue, the same healthcare professionals can help with that too.
Stress
Stress can also shut down ovulation, and consequently your period, as we discussed in a previous article on adrenal fatigue vs. HPA axis dysfunction. Sometimes when we experience significant stress for a long time, it feels like our “normal.” A family member or close friend may be able to shed light on whether you’re chronically stressed, in which case stress reduction techniques like meditation, guided visualization, prayer, etc. and learning mindset management through coaching or counseling to develop or improve coping techniques and healthier patterns of relating and communicating may be helpful.
Consider hormonal causes
Polycystic ovary syndrome (PCOS) and thyroid conditions, as well as benign pituitary gland tumors and premature menopause, can all shut down ovulation, leading to amenorrhea. If you’ve been diagnosed with polycystic ovary syndrome in the past, you can certainly try diet- (discussed here, here, and here) and lifestyle-modifications to see if your period returns.
Check medications
If your period has stopped, your medication(s) might be to blame, particularly if you take anti-seizure medicine, an antidepressant, antipsychotic, allergy medicine, certain blood pressure medicines, or chemotherapy to treat cancer. If you suspect a medication might be connected to your amenorrhea, reach out to your primary care provider.
Ultimately, if improved stress management and diet or lifestyle changes don’t bring your period back on their own, or in tandem with making progress in these areas, it may be time to see a healthcare provider.
Reach out to a restorative reproductive medicine-trained professional for amenorrhea treatment
Restorative reproductive medicine (RRM) is defined by the Institute for Restorative Reproductive Medicine as “a medical discipline that looks to identify and treat the root cause of reproductive problems, aiming to treat, optimize, and restore the patient’s health.” The operative words in this definition are “root cause.” in contrast, hormonal birth control—which many medical doctors trained in internal medicine, pediatrics, or OB/GYN may encourage women to take to “regulate” their cycle—simply puts a Band-Aid on the problem.
Instead of making periods return, birth control will cause a withdrawal bleed, which is not the same as a regular period, because it’s not preceded by ovulation. Rather than using birth control to essentially “fake” the return of a period, RRM providers seek to figure out why someone isn’t having a period, and treat that cause.
What’s included in a diagnostic workup for amenorrhea?
When you (or your daughter) go to the doctor because periods have stopped, he or she will ask lots of questions (so be sure to come prepared with answers!), perform a pelvic exam, order a urine pregnancy test to rule out pregnancy, as well as blood tests to evaluate thyroid function and other hormone function, and perhaps order imaging like an ultrasound, CT scan, or MRI.
Sometimes a doctor will look inside your body with a scope, called hysteroscopy, to examine your uterus. In hysterosalpingography, “x-rays are taken after a substance that can be seen on x-rays (a radiopaque contrast agent) is injected through the cervix into the uterus and fallopian tubes.” If you have fertility awareness cycle charts, these will be especially helpful for a RRM provider to review to look for patterns consistent with different causes of amenorrhea.
What treatment options exist for amenorrhea?
Ultimately, resolving amenorrhea requires addressing the specific root cause(s). For girls experiencing primary amenorrhea due to a blockage within the reproductive system, for example, surgery may be necessary. Surgery is also the treatment for Asherman syndrome, in which scarring caused by a previous D&C, Cesarean section, or other uterine procedure prevents menstrual blood from evacuating the uterus, leading to apparent amenorrhea. See above for treatments of amenorrhea related to weight, unhealthy stress, and overexercise. Amenorrhea caused by hormonal abnormalities requires addressing thyroid or other dysfunctions. With PCOS, medications like Clomid may be given to jumpstart the ovaries to trigger ovulation, hopefully leading to the return of menstruation. Pituitary gland tumors may require medication to shrink them, or even surgery.
Seek amenorrhea treatment from a RRM-trained healthcare provider
If you’re experiencing amenorrhea, take heart. Once you determine the cause, you can pursue solutions. Start by addressing lifestyle factors and/or obvious reasons for your period to stop. If and when you decide it’s time to seek outside help, work with a RRM-trained provider, like a NaPro, Neo, or FEMM provider, who will ensure that you or your daughter are not simply placed on hormonal birth control, which fails to address the real issue and comes with a host of risks and side effects.
Additional Reading:
How charting your cycle can help you understand stress effects
What are the symptoms of PCOS, and how do you treat it?
The emotional effects of PCOS: the lies it tells me and how I battle them
