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Amenorrhea (ei · meh · nr · ee · uh): Where Did My Period Go?

October 22 2020 | Written by Miranda Vanhaarlem (She/Her), Graphics by Sissi Chen (She/Her)

“Did you forget to log your period? You should be on day 3 of your cycle!”

That is what I woke up to on the morning of March 27th, 2020. Casually, I ignored this notification and went on with my day of online schooling, only a week after everything in Ontario shut down. My period was the least of my worries given that the world was quite literally falling apart, so I continued to ignore my period app’s notifications. I blinked and it was May when I finally decided to open up my period app and noticed that I had completely missed three cycles. I know a common thought would be that one is pregnant, but my hormonal IUD was telling me that was not the case. I have had a hormonal IUD for almost four years now and my periods have been regular for three of those years, so missing three periods was odd. In June, I decided to book an appointment with my gynecologist even though I was dreading the pap smear that I knew was going to come along with it. After explaining my situation to my doctor, she was quite focused on how much life shifted at the end of March and it made me question what the heck COVID-19 had to do with me missing three periods. And then she stated, “I think you may have secondary amenorrhea”. All I could think at that time was “amen huh?”. 

What is Amenorrhea?

According to the American College of Obstetrics and Gynecology, Amenorrhea is simply the absence of menstrual periods. Menstruators who have missed three or more periods in a row can be diagnosed with Amenorrhea, which comes in two types: primary and secondary.

In fact, 1 in 25 menstruators who are not pregnant, breastfeeding, or going through perimenopause/menopause will experience secondary amenorrhea at some point in their lives. 

In my situation, I was experiencing secondary amenorrhea as I had not had a cycle for the months of March, April, and May, and would continue to not have one in June. 

What are the common symptoms of Amenorrhea? 

Amenorrhea symptoms manifest differently depending on the root cause. Some common symptoms of Amenorrhea include: 

  • Alopecia (Hair Loss) 

  • Headaches 

  • The Growth of Facial Hair and/or Excess Facial Hair 

  • Pelvic Pain 

  • Acne 

  • Vision Changes 

  • Milky Nipple Fluid 

(American College of Obstetrics and Gynecology)

Looking back, my only symptom of Amenorrhea was the absence of my monthly flow. I have always struggled with my skin and did not notice an increase or a decrease in the number of breakouts I was having. I know some menstruators enjoy not having their monthly flow but, personally, I didn’t feel like myself without it. I didn’t feel healthy. 

What are the causes of Amenorrhea?

Primary Amenorrhea

Primary amenorrhea is usually the result of a genetic or anatomic condition. Often times, the route cause of amenorrhea can go unknown but when a cause is identified, it can usually be divided into three categories: 

  1. Genetic Conditions such as Turner Syndrome and Androgen Insensitivity.

  2. Complications with the hypothalamus and/or pituitary gland that play a primary role in the regulation of ovarian hormones which are responsible for menstruation.

  3. Complications with the development of the female sex organs such as the uterus, ovaries or vagina such as Gonadal Dysgenesis.

Secondary Amenorrhea 

There are many known causes of secondary amenorrhea, some more common than others, and some are easier to pinpoint as the root cause than others. Pregnancy and breastfeeding happen to be the most common causes of secondary amenorrhea but others can include: 

  • Low body weight 

  • Extreme exercise

  • Poor nutrition 

  • Rapid weight loss or weight gain

  • Eating disorders 

  • Polycystic ovary syndrome (PCOS)

  • Complications with the thyroid gland

  • Emotional and/or physical stress 

  • Chronic medical conditions, such as kidney failure or inflammatory bowel disease (IBD)

  • Elevated levels of androgens (male hormones)

  • Certain Birth Control methods 

  • Poor nutrition 

And that’s where it hit me: so many aspects of my life changed at the end of March causing my body to be under extreme physical and emotional stress. While I barely noticed the elevated stress levels as I pushed them aside in order to get through each day, my body and thus my hormones were suffering greatly. The relationship between stress and menstruation is not common knowledge and, even though I study women’s health every day, I barely knew anything about it.

Stress plays a huge role in suppressing the functioning of the hypothalamus, which in turn controls the pituitary gland. The pituitary gland just so happens to control the adrenal gland, thyroid gland, and the ovaries. They all work to manage and control our hormones, and when one is affected - particularly the hypothalamus - so is everything else. 

What are the common treatments for Amenorrhea?

Treatments options depend on the specific cause of Amenorrhea. You should visit your health care provider if absent menstrual cycles become regular. For primary amenorrhea, medical tests and hormonal therapy can be tried in order to tackle the underlying conditions. For secondary amenorrhea, treatment varies greatly. For example, if an individual has lost their period due to extreme exercise, a decrease in exercise could be beneficial. In general, individuals with secondary amenorrhea will benefit from a healthy diet and daily exercise.

As soon as I acknowledged the relationship between my menstrual cycle and the emotional and physical stress I was putting my body through, I took action. While it isn’t good to ignore what is going on in the world, I had to for a while. Watching the news or scrolling through social media did nothing positive for my mental health, so I focused more on myself than the outside world. This felt extremely selfish, especially with what is going on in the world today, but I had to prioritize my own well-being before others. It’s like when the flight attendants tell you to put your own oxygen mask on first. By prioritizing my own needs and getting into a covid-friendly routine, I got my period back in July. I didn’t think getting menstrual cramps could ever make me happy, but they did. 

Are there any long term health consequences due to Amenorrhea? 

In short, yes. If one does not combat the underlying cause of their amenorrhea, they may see long term health consequences. The menstrual cycle can be described as an extremely important reproductive vital sign. A study conducted at Barbra Streisand Women’s Heart Center in Los Angeles focused on the significance of estrogen in other key body processes besides fertility. This study found that young menstruators who have functional hypothalamic amenorrhea (a form of secondary amenorrhea) are present with estrogen deficiency. This disorder is oftentimes caused by disordered eating, psychological stress, or excessive exercise, and in turn, results in the suppression of the hypothalamic-pituitary-ovarian axis. The long term health consequences of estrogen deficiency go beyond reproductive issues as it has been strongly linked to cardiovascular consequences, bone consequences and has been shown to have negative psychological impacts. 

The Glorification of Amenorrhea

Far too many times have I seen menstruators bragging about the loss of their menstrual cycle as if it is an award that only some can win. While as a menstruator myself can completely understand how inconvenient and down-right painful a cycle can be, I still wonder why amenorrhea is bragged about. Part of me wonders if we’ve been conditioned to think our menstrual cycles are negative and therefore almost have a sense of pride when it is absent. 

Dr. Michael Cackovic, an American board OB/GYN, describes hypothalamic amenorrhea as followed, “essentially the body is going into survival mode, telling the brain that the body’s energy is best spent elsewhere”. Why is it normalized to brag about the body going into survival mode

I’ve noticed that this pattern is extremely evident in the CrossFit/bodybuilding/weightlifting community. In the novel, “No Period. Now What?” Dr. Nicola Rinaldi works to share her extensive research on hypothalamic amenorrhea and help menstruators who have recently lost their cycles get back into a state of balance. One of the stories shared is that of Laura, an elite bodybuilder/weightlifter who lost her period for a couple of years due to a combination of physical and mental stress alongside restrictive eating patterns. Laura states,  

“I ignored warning signs…fatigue/waking up exhausted, no period and feeling hungry all the time despite consuming 2,700+ calories a day at this point. My Dexa scans kept showing my bone density was in a healthy range so I just kept ignoring the fact that my body-fat was so low and my period was MIA. I figured I’d address the issue later since I was so laser-focused on competing.” 

In my opinion, amenorrhea is nothing to brag or joke about as it is usually a sign of another underlying health condition. I want to acknowledge that menstruators that lose their period can oftentimes be left working for years on their health in order to get their natural cycle back. I also want to acknowledge that menstruators with conditions such as PCOS, endometriosis and adenomyosis, can suffer from periods that are debilitating and I am in no way trying to tell these individuals to be grateful for their periods. But for the rest of us, our cycles are an amazing sign of vitality and that is frankly why I am starting to appreciate my monthly flow.