AMENORRHEA: I’M NOT GETTING A PERIOD, AND I KNOW I’M NOT PREGNANT. SO WHAT?

Why the lack of a period needs to be evaluated by your doctor.

Secondary amenorrhea occurs when women who have previously had a period and now are not. The actual definition is the cessation of menses for 3 months in women with previously regular cyclic periods or 6 months in women with a history of irregular periods. Many women, if not concerned about pregnancy, see no problem with not having a regular period. Medically, however, not having a regular menstrual cycle is a concern that needs to be addressed.

Amenorrhea has many causes. Medical evaluation is needed to consider an array of possible diagnoses all the way from your hypothalamus or pituitary gland to your uterus and ovaries, even abnormal thyroid function can play a role in why you aren’t getting your period.

We still haven’t answered the burning question. Is it really that big a deal if you aren’t getting your period? Yes, it is. Amenorrhea can be due to a variety of causes, all of which have different risks associated with them.

If your lack of period is due to low estrogen, or a hypoestrogenic state, you increase risk factors that usually increase in menopause. With a decline in estrogen, bone mineral density also declines, increasing risk for osteoporosis. Also, low estrogen levels have been shown to have a negative effect on lipid levels and can increase risk of cardiovascular disease. Usually this decline happens later in life so the risks can be better mitigated due to timing. If at 25 you have the estrogen levels of a 45 year old, you are at much higher risk for problems later on in life.

If your lack of period is due to low progesterone, or an “unopposed estrogen” state, you end up with a whole other set of risk factors. In this scenario, many women are experiencing a lack of ovulation. They have enough estrogen to build the lining of the uterus, but not enough progesterone to shed it (which happens when you get your period). This can lead to a thickened endometrial lining, or endometrial hyperplasia, which carries with it an increased risk for endometrial cancer. Polycystic ovarian syndrome (PCOS) is often an example of this kind of amenorrhea.

Another risk that many women do not think about in their younger years is difficulty conceiving when the time is right. Most women wait until they want to get pregnant to think about getting their hormones properly balanced. In reality, this often leads to frustration and stress as hormonal evaluation and treatment takes time.

The nice thing is, once the cause of your amenorrhea is determined, there are many treatment options available that go far beyond just a birth control pill. Natural hormone balancing is very effective, and offers treatment options that fit with your lifestyle as well as your future goals. If necessary, these can be combined with bioidentical hormone replacement to start menstruation and regain regular periods.

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