What are some reasons for heavy periods

Amenorrhea

Brief overview

  • What is amenorrhea? The absence of a woman's menstrual period.
  • causes: natural causes are pregnancy, lactation and menopause; Pathological causes are e.g. stress, (too) low body weight,
  • Treatment: depending on the cause of the disease-related amenorrhea, e.g. B. Stress reduction, relaxation techniques, hormone administration, training reduction, weight gain, surgery for tumors
  • Consequences: Inability to get pregnant; psychological problems (feelings of inferiority, not feeling "like a woman")

Amenorrhea: definition

Amenorrhea describes the absence of menstruation (menstruation). This is quite natural during pregnancy and breastfeeding. Girls also don't have periods before puberty. And with the menopause, egg maturation is exhausted, which also gradually subsides the menstrual cycle - until the period stops completely.

In addition to these natural causes of amenorrhea, missed periods can be the result of an illness or (hormonal) disorder. At this pathological amenorrhea Doctors distinguish between two forms:

  • primary amenorrhea: This occurs in women who have never had a menstrual period up to the age of 16.
  • secondary amenorrhea: One speaks of this if the menstrual period has not been running for more than three months, but the women concerned previously had a normal cycle.

Amenorrhea: causes and possible diseases

A woman's menstrual cycle is kept going by the interaction of various hormones (such as GnRH, FSH, LH, estrogens), which two brain regions in particular are involved in controlling - the hypothalamus and the pituitary gland (pituitary gland). Amenorrhea is very often caused by a disturbance in this complex hormonal system.

In addition, organic disorders such as organ malformations can also be responsible for the absence of menstrual bleeding.

The most important causes of primary and secondary amenorrhea are presented in more detail below (natural triggers of amenorrhea such as pregnancy or menopause are not discussed).

Primary amenorrhea

Young girls usually have their first menstrual bleeding between the ages of 11 and 13. If this does not occur by the age of 16, doctors speak of primary amenorrhea. The causes for this are usually innate.

So can certain Chromosomal disorders cause the ovaries not to respond to hormonal signals from the brain or the reproductive organs to develop improperly. This is the case, for example, with Turner syndrome, Klinefelter syndrome or androgen receptor defects. That too system-related lack of functional egg cells (Gonadal dysgenesis as in Turner syndrome or Swyer syndrome) as well Malformations in the genital area are possible causes of primary amenorrhea. The same applies Intersex (Here the genetically determined sex and the developed sexual organs do not match).

Occasionally, serious illnesses such as cancer and its therapy, disorders of the thyroid or adrenal cortex, autoimmune diseases such as type 1 diabetes or rheumatoid arthritis in childhood are the cause of primary amenorrhea.

Secondary amenorrhea

Important reasons for secondary amenorrhea are, for example:

  • Stress: An important trigger for amenorrhea are, for example, emotional tensions, severe crises, time pressure, travel and important decisions to be made. Exactly how the soul influences hormone production is not yet fully understood. However, stress has a direct effect on the hypothalamus and can thus lower the GnRH concentration, which disrupts the cycle. Mental stress can trigger amenorrhea, especially in women who already have a rather irregular cycle.
  • Competitive sport: Excessive training also means stress for the body and soul and lowers the GnRH level.
  • severe weight loss or low body weight: If the woman's body fat percentage falls below a critical value, the organism no longer produces enough hormones to trigger ovulation. Because if the weight is too low, pregnancy would be dangerous for mother and child. That's why the body doesn't even let it happen - it suspends the period. Especially in connection with anorexia nervosa and bulimia, (too) low weight can bring the cycle to a standstill.
  • severe mental and physical illnesses: They are also powerful stressors that, among other things, can reduce GnRH production.
  • Incorrectly nested egg: If a fertilized egg nests outside the uterus (ectopic pregnancy), the hormonal effects on the body are similar to those of a normal pregnancy - the menstrual period stops.
  • Polycystic Ovarian Syndrome (PCO syndrome): Here the hormone production in the ovaries and in other hormone-producing tissues is disturbed. Among other things, numerous fluid-filled vesicles (cysts) develop on the ovaries. Ovulation often does not occur, and so does the menstrual period.
  • Thyroid Disorders: They also disrupt the hormonal balance. Both overactive and underactive thyroid can prevent menstrual bleeding.
  • increased prolactin production: The hormone prolactin inhibits the cycle during pregnancy and breastfeeding and stimulates the production of milk in the breast. In Chiari-Frommel syndrome, prolactin production remains high even after breastfeeding - the milk flow persists for months to years, and amenorrhea occurs. In addition, certain drugs and tumors can also stimulate prolactin production.
  • premature menopause: In some women, the ovaries stop functioning before their 40th birthday. Doctors then speak of premature menopause.
  • Brain inflammation: If they occur in the area of ​​the pituitary gland or the hypothalamus, they can disrupt their function - the period does not occur.
  • Tumors: Both benign and malignant tumors can prevent menstruation. These include tumors on the ovaries, but also in the brain (especially in the area of ​​the hypothalamus and pituitary gland).
  • Ovarian disorder: z. B. due to cysts, surgery, tumors or radiation. Even if the ovaries do not respond to hormonal control by the brain, this can prevent menstruation.
  • Damage to the lining of the uterus: Surgery (such as scraping) or inflammation can damage the uterine lining to such an extent that it can no longer build up sufficiently. Then the menstrual period stops.
  • chronic kidney failure: Chronic kidney failure has significant effects on the entire organism. Among other things, it can impair the functioning of the genital organs.
  • Adrenal Disorders: Such diseases can be accompanied by an overproduction of the stress hormone cortisol (Cushing's syndrome). This disrupts the cycle up to and including the absence of menstruation.
  • Medication: Hormone preparations, cancer drugs, psychotropic drugs, cortisone and antihypertensive drugs can disrupt the menstrual cycle.
  • Withdrawal from hormonal contraceptives: Menstruation may be temporarily absent, especially after the three-month injection. This happens less often after stopping the “pill” (post-pill amenorrhea).
  • Deliveries with severe blood loss: They can be caused, for example, by a certain functional weakness of the pituitary gland, the so-called Sheehan's syndrome. Affected women do not have a menstrual period for an unusually long time after giving birth (and breastfeeding).

Diseases with this symptom

Find out here about the diseases that can cause the symptom:

Amenorrhea Treatment: What Does the Doctor Do?

Treatment for amenorrhea depends on the underlying cause of the symptom. For example, hormonal disorders can in many cases be regulated by administering hormone preparations. If the amenorrhea is caused by tumors or malformations of the genital organs, surgery is often the only solution. If the amenorrhea occurs as a result of psychological stress or disorder, psychotherapy can be the method of choice.

In order to initiate the correct treatment, the doctor must first determine the exact cause of the amenorrhea.

diagnosis

The first important step in the diagnosis of amenorrhea is this Medical history survey (Anamnese). In a conversation with the patient, the doctor collects important information, for example when the last menstrual period was or whether the woman has ever had a cycle. He can also ask whether there is a possibility of pregnancy and whether there are any other symptoms besides the amenorrhea.

The anamnesis interview is followed by a gynecological check which includes a vaginal swab and an ultrasound scan of the abdominal organs.

Hormone measurements can also provide important information about the causes of amenorrhea. Prolactin, progesterone, estrogens, the male sex hormones (androgens) and the hormones FSH and LH produced by the pituitary gland are determined. If a disordered thyroid function is suspected as the cause of the amenorrhea, the doctor takes a close look at the blood levels of the thyroid values ​​(TSH, T3, T4).

There are also certain Function tests. A few examples: For the so-called progestin test, the patient takes a progestogen preparation for a few days. If bleeding occurs after weaning, this shows that the uterine lining was actually sufficiently developed - that is, sufficient amounts of estrogen had been produced beforehand because this stimulates the build-up of the uterine lining. The amenorrhea must then have other causes.

If the test is negative, an estrogen-progestin test can be considered. This can be used to check whether the uterine lining can be sufficiently activated at all. The doctor first gives the patient estrogens, which stimulate the build-up of the uterine lining, followed by progestin. If subsequent bleeding occurs, this indicates that the lining of the uterus is intact.

Depending on the suspected cause of the amenorrhea you can further investigations to be necessary. These include, for example, imaging procedures - for example if a tumor in the brain is suspected - or a laparoscopy (laparoscopy) to assess the condition of the ovaries.

Amenorrhea Treatment: What You Can Do By Yourself

Amenorrhea is often psychological. In this case, anything can help that strengthens your psyche and brings it back into balance. This includes relaxation techniques such as autogenic training, progressive muscle relaxation or meditation. But exercise is also a good method to reduce stress and regain your inner balance. Because the body increasingly produces those hormones that reduce or neutralize the stress hormones (e.g. serotonin, endorphins).

If, on the other hand, too intensive sports training is behind the amenorrhea, you should take it easy. If you do not have a menstrual period because you are too thin or you are on an extreme diet, you should try to gain weight again - adipose tissue plays an important role in the production of estrogen. If your amenorrhea is the result of an eating disorder such as anorexia, you should definitely seek professional help. Anorexia is a life-threatening condition that can only be overcome with psychotherapeutic help.

Important investigations

These examinations help to find out the causes of the symptoms:

Amenorrhea: consequences

If there is no menstrual bleeding, this can have various consequences for the affected woman.

  • no pregnancy: Without an intact menstrual cycle, a woman cannot become pregnant. So if the menstrual period stops longer, the desire to have children remains underfilled.
  • Problems in the partnership: Missing periods can make women feel less feminine. Even the frustration of not getting pregnant due to amenorrhea can cause a long-term stressful partnership to break it in the worst case.

Amenorrhea can indirectly have another consequence: If the absence of the menstrual period is due to a lack of estrogen, this can make the bones more fragile over time - osteoporosis threatens.

Amenorrhea: when do you need to see a doctor?

If you miss your period, a visit to the doctor (gynecologist) is advisable. This is especially true when

  • You may be pregnant.
  • You have missed three menstrual periods in a row.
  • You have not had your first menstrual bleeding even after your 16th birthday.
  • Your period does not stop after you start taking a new medication.
  • You have stopped bleeding after you stopped taking the pill or other hormonal contraceptives.
  • You have stopped menstruating after an operation.
  • In addition to the absence of the norm, you notice other symptoms such as abdominal pain, pain during sex, chest pain or milky discharge from the breasts.
  • In addition to amenorrhea, you also notice signs of masculinization (virilization) such as hair loss, deeper voice, stronger and more masculine body hair (such as beard and chest hair).

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