Amenorrhea: the Absence of a Menstrual Cycle
There is such a thing as having no menstrual cycle. However, if you don’t begin menstruating by the age of sixteen, there are some birth defects and potentially serious conditions that can prevent menstruation. It’s important to diagnose these as soon as possible.
There’s usually a hormonal imbalance that is easily remedied with oral contraceptives or hormonal supplements. If you’re menstruating regularly, and are between the ages of twenty and forty, it’s unusual to simply stop menstruating.
If this does occur, pregnancy, obesity (fat cells make more estrogen than your body needs, which interferes with ovulation), food refusal (anorexia nervosa), or vomiting/purging (bulimia) are common causes. When the problem is starvation-related, a protective mechanism is triggered in the body.
When the female body is malnourished, it stops ovulating because it can’t sustain a pregnancy. One doctor told me about an aboriginal tribe in Australia that demonstrates this unique protective mechanism. Women of that particular tribe menstruate only at certain times of the year, when the food cycle is abundant.
Athletes, again, may experience amenorrhea, and either an overactive or underactive thyroid gland can cause it. Progesterone supplements will remedy it.
If you skip periods, medication may be prescribed in either progesterone or oral contraceptive form.
The Need to Bleed
Today, women have to deal with more periods in their lifetime than women did in the past due to fewer pregnancies and a longer life cycle. Also, in the past century, women have experienced a radical change in diet, environment, stress levels, career, and family expectations. Understandably, the accumulated effect of all these factors has affected the hormonal cycle of women, which in turn, affects the menstrual cycle.
If you’ve missed more than two periods and know for certain that you’re not pregnant (either confirmed by a pregnancy test or the absence of any sexual activity) then you need to see your doctor and have your period “induced.” You’ll be given a progesterone supplement, which will jump-start your cycle. It’s dangerous to go longer than three months without a bleed; if the uterus isn’t regularly cleaned out, the risk of uterine cancer increases.
Menorrhagia: Extremely Heavy Flow
If you have an extremely heavy flow, it may be normal for you. A lighter flow can also slowly develop into a continuous heavy flow, or you may experience an isolated bout with it. In general, if you need to change your pad or tampon every hour, your bleeding may be unusually heavy. You’ll need to get this checked out. There usually isn’t anything to worry about.
You should have your blood levels checked regularly (every six months), however, because consistent heavy flows could cause anemia. In fact, the number-one cause of anemia is a heavy menstrual flow. If this is the case, have a doctor evaluate you to uncover an underlying cause of your heavy bleeding. If no specific abnormality is found, the flow can be decreased with oral contraceptives.
Nonsteroidal drugs such as ibuprofen, taken at the strength of 400 mg every four hours, can reduce your flow up to 40 percent. Even if ibuprofen doesn’t work, this therapy is harmless at worst.
Amenorrhea diagnostics: What your doctor should rule out
If you notice abnormal bleeding either during or between periods, make sure your doctor rules out the following: hyperthyroidism or hypothyroidism (an over- or underactive thyroid gland), ovarian cysts, abnormal tissue within your uterus, as well as endometriosis (discussed further on).
Your doctor should also perform a pelvic exam, as well as a transvaginal ultrasound, a procedure where a “dildo”-shaped transducer with a condom on it is inserted into your vagina by the ultrasound technician. Transvaginal ultrasound produces much sharper images than does abdominal ultrasound.
Of course, your doctor should also be ruling out symptoms of possible sexually transmitted diseases (STDs).
Amenorrhea treatment: How do they treat abnormal bleeding?
Treatment varies from woman to woman and has to do with age and reproductive history. Treatments can include an oral contraceptive containing new progestin derivatives that help to raise your HDL, the “good cholesterol” (if you are healthy and don’t smoke). In fact, low-dose contraceptives are absolutely fine right up until menopause, as long as you have no health problems or risks.
If you’re trying to conceive, on the other hand, a fertility drug such as clomiphene citrate, will also regulate your cycle and should take care of the problem.
If you’re between thirty and forty, and don’t want to be on contraception, you can request to be treated with medroxyprogesterone acetate (Provera). The usual dose is 5 to 10 mg daily ten to fourteen days a month, in a “two weeks on/two weeks off,” cycle.
This tends to work better if you have anovulatory cycles. Finally, a nonsteroidal anti-inflammatory drug (NSAID) will reduce your menstrual flow.
A common prescription NSAID is naproxen sodium (Anaprox). The usual dose is 275 mg two to four times a day.
If none of these treatments help, you should be evaluated for more serious conditions, such as endometriosis, discussed further on.