Where's my period gone?





Ever lost your period or wondered how on earth your period could just stop?


I know those people out there that suffer through their periods might be thinking, wow that sounds like bliss! However, loss of menstruation can lead to more health complications which can impact your future health.


Amenorrhoea and the two types.


Amenorrhoea (absence of menstruation) is termed after the absence of a period for more than 6 months. We like to look at this as less of a ‘condition’ and more of a ‘symptom’ of something else going on within the body. Which is why we investigate and find the cause for why this is occurring and aim at treating the root issue.

There are two types:


Primary amenorrhoea

  • Termed when menstruation has not commenced by age 17

Secondary amenorrhoea

  • Cessation of menstruation for more than 6 months during any years after your menstruation has started

  • Secondary amenorrhoea is a more common type that we can see anywhere in the lifespan up until menopause

Why does this happen?


As mentioned, amenorrhoea is a symptom of something deeper that is going wrong in the body. There are a few reasons why your period may stop and it is important to understand which reason sounds true for you.



Structural abnormalities in the uterus.

  • Structural issues can cause a few complications when it comes to bleeding via menstruation, as blood flow can become obstructed or blocked and thus causing cessation of menstruation.

  • Tissue abnormalities caused by inflammation or destruction can also occur.

  • Asherman's or Cervical stenosis can impact normal bleeding which can result from invasive intra-uterine surgeries, cauterisation or laser surgery. This can be more difficult to treat due to the difficulties in correcting structural integrity in the uterus and consultations with specialise surgeons is needed.


Hypothalamic amenorrhoea.


This is probably the most common cause of amenorrhoea seen in the younger population and can respond well to the correct interventions. It is important to identify the drivers for hypothalamic amenorrhoea to target treatment correctly.

The following factors can interfere with GnRH secretion which leads to poor communication between the hypothalamus and ovaries, thus leading to absent menstruation.


1. Stress

  • Stress negatively impacts ovulation and hormonal signalling. Commonly things such as emotional stress, relationship issues, environmental stress, work, study, trauma and travelling can drive amenorrhoea.

2. Low body weight or weight loss

  • Long term low body weight or intentional excessive weight loss can lead to amenorrhoea due to lower levels of hormones such as oestrogen and progesterone.

  • Most research indicates a body fat percentage less than 22% can create a risk of menstruation cessation.

  • Low body weight often stems from low oral intake or poor eating habits, individuals with a history of eating disorders or disordered eating patterns are at higher risk of amenorrhoea.

3. Excessive exercise

  • GnRH secretion from the hypothalamus is negatively impacted by excessive exercise. This of course is all relative to your other lifestyle factors. My general guide, is if you feel lethargic or tired an hour or so after exercising you may be overdoing it.

4. Contraceptive pill cessation

  • Post-pill hormonal complications are quite common and it can often take a few months before a regular cycle and menstruation returns, the usual time it takes is within 3 months of cessation of the pill.

  • Post-pill PCOS or pre-existing PCOS is another common irregularity which can lead to amenorrhoea.

5. Chronic illness or lesions

  • Conditions affecting the hypothalamus can lead to amenorrhoea, as well as chronic organ conditions related to the liver and kidneys,

  • Lesions on the hypothalamus can lead to lowered levels of FSH and LH which means ovulation does not occur and neither does menstruation

Other conditions and situations that can lead to amenorrhoea:

  • Hypothyroidism

  • Pituitary tumours

  • Hyperprolactinaemia

  • PCOS

  • Annovulation

  • Pregnancy and breastfeeding

  • Androgen excess

  • Certain medications

Diagnosis of amenorrhoea can be confirmed based on symptom assessment and case taking but pathology and testing can also be completed with your practitioner.


Why is this an issue?


Amenorrhoea can have implications on bone density later in life due to the associated lower levels of oestrogen. Osteoporosis is a common complication of amenorrhoea and is usually witnessed later in life post menopause, however younger people are suffering poor bone density due to issues related to amenorrhoea. Low bone density leaves you susceptible to fractures, limited mobility and pain.


Ovulation and menstruation are important indicators of health to allow for your normal cascades of hormonal reactions to occur, as always, if something is not happening correctly in the body it can create an imbalance in many other systems.


So what can you do?


  1. See a practitioner with experience in the area to give you the best treatment possible! A good practitioner will educate you, advise you and guide you in the best direction of how you can re-balance your body.

  2. Finding the cause for why the amenorrhoea has occurred is paramount, without this things may not change or if they do it may only be a temporary fix.

  3. Improving your eating habits and eating a well balanced range of foods to regulate your body weight and nutrition status. This is where practitioner support is crucial however as a general rule, eating a source of protein, carbohydrates and essential fatty acids with each meal is a good way to refuel.

  4. There are some beautiful herbs such as Paeonia lactiflora, Vitex agnus-castus, Serenoa repens and Dioscorea villosa are some of my favourites however there are so many complimentary herbs that can be used depending on your presentation.

  5. Specific nutrient replacement can be indicated to ensure you have all the precursors you need to be supporting ovulation and hormone production.

  6. Stress reduction and outlets for stress, this includes exercise as the body can view excess exercise as a stressor. This is individual and often cannot be figured out on your own, reach out if you need guidance in this area.


A final note


Remember, the contraceptive pill will not regulate your hormones, the bleed you experience whilst being on contraception is a withdrawal bleed from the synthetic hormones not a 'period'. The pill is a temporary solution to a problem that is very treatable with the right support.


As always, any questions or comments drop them below.


Yours in good hormonal health,


Brooke x




References:


Altayar, Osama, Alaa Al Nofal, B. Gisella Carranza Leon, Larry J. Prokop, Zhen Wang, and M. Hassan Murad. 2017. “Treatments to Prevent Bone Loss in Functional Hypothalamic Amenorrhea: A Systematic Review and Meta-Analysis.” Journal of the Endocrine Society 1(5):500–511. doi: 10.1210/js.2017-00102.

McGee, C. 1997. “Secondary Amenorrhea Leading to Osteoporosis: Incidence and Prevention.” The Nurse Practitioner 22(5):38, 41–45, 48 passim.

Trickey, Ruth. 2004. Women, Hormones and the Menstrual Cycle: Herbal and Medical Solutions from Adolescence to Menopause. St. Leonards, N.S.W.; London: Allen & Unwin ; Orion.

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In the spirit of reconciliation, Goodkind  Naturopathy acknowledges the Traditional Custodians of our country, the Yugambeh language group and their connections to land, sea and community. We pay our respect to their elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

 

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