Women's Health Series: Amenorrhoea or Absent Periods

This week, Dr. Nick continues his series on Women's Health. In this article, we'll look at what can cause your periods to cease. In the medical profession, this is known as secondary amenorrhoea. We’ll cover what to do if you suffer from this issue, but what we won’t cover in this blog, is primary amenorrhoea: when a female’s period has not started by aged 16.

So, you've missed a period. The first thing to do, is rule out pregnancy. Get a pregnancy test available at any pharmacy and make sure.  Being pregnant and not knowing can obviously have significant consequences, however, if the test is negative and you don't have a period for six months, you need to see your GP. 

The majority of cases I see in my clinic of women that have not had a period for a few months, are usually as a result of having stopped an oral contraceptive. If however this has gone on for more than four to five months, then a more thorough look at the problem is warranted. 

In 1/3 of the cases where a period has stopped, it’s due to what's known as Hypothalamic. This is commonly due to the hypothalamus gland in the brain being suppressed from producing the relevant sex hormones. It is commonly caused by excessive weight loss (especially anorexia nervosa), excessive exercise or stress. I saw two cases this year, one was an anorexic girl, who had a BMI (Body Mass Index) of 18 and the other was a girl who ran a lot of marathons. In fact 44% of competitive female athletes have amenorrhoea. Usually a reduction of exercise intensity by 10-20%, should be enough to reverse the symptoms and if you feel you may have an eating disorder, please see your GP as there is lots of help out there. 

In the other third of cases, the reason is usually Poly-cystic Ovary Syndrome (PCOS). This is a condition where the ovaries have lots of follicles, there is an excess production of male hormones and periods can be irregular. If you have excessive facial or body hair, weight gain, generally irregular periods, acne or have had difficulty getting pregnant, this may be the cause and you should see your GP. 

Another reason could be due to an under active thyroid. The thyroid gland controls the body's metabolism and so if this is low, one of the features could be irregular or absent periods. Look out for tiredness, weight gain, aches and pains, constipation and sensitivity to cold, not exactly uncommon symptoms. More often than not these won't be associated with a thyroid problem, but just a side-effect of life in the fast-lane! However, its always best to rule out this condition. 

The other causes which are less common, are early menopause and Hyperprolactinaemia (I think we may have used this word in one of our drinking games at med school). The latter is an excess production of the hormone that causes milk production and can be as a result of stress, certain medication or a non-cancerous growth in the gland that sits in the brain. Certainly if you have any symptoms of lactation or visual disturbance, speak with your GP. 

The thing I urge most is paying attention to your body. If things have changed from what it ‘normal’ for you, seek advice from a medical professional. Every body is different but you know yours best! If you think you may be suffering from any of the above, please refer yourself to your GP and get it checked out!

This blog is written by friend of Neat, Dr Nick Ambatzis MB BS, MSc (SEM), MRCGP.

Nick is a General Practitioner specialising in Sports and Exercise Medicine. He completed his medical degree at University College London Medical School in 2002. Nick worked for almost ten years as a junior surgeon and spent three years in Trauma & Orthopaedics. He attained a Masters in Sports and Exercise Medicine and subsequently trained as a GP practising in Paddington.

From an early age, Nick has been both a keen cross-country runner and water-polo player, having competed at college level. Nick is also an accomplished ultra-marathon runner, having competed in many cross-country and cross-alpine races, ranging from 50-100 miles. He has also been a Crossfit and Crossfit Endurance coach.