Regular periods are generally a symptom of good health – a reassuring sign that everything is functioning as it should. It's no wonder then that many women become anxious when periods suddenly become erratic, or stop altogether.
Here are some of the most common causes of secondary amenorrhoea:
If a fertilised egg is implanted in the uterus lining, menstruation ceases. Even after childbirth, periods may not resume whilst a woman is breast feeding – this is called lactation amenorrhoea. Although the risk of pregnancy is reduced during this time, this is not a reliable contraceptive method.
Mental and emotional health
In some cases, amenorrhoea is a symptom of a serious psychological problem. Severe stress or depression can alter the functioning of the hypothalamus and anterior pituitary gland – the areas of the brain that release hormones that regulate the menstrual cycle. This may temporarily prevent menstruation.
Body weight and excessive exercise
Amenorrhea is often associated with malnutrition, low body fat and excessive exercise. Eating disorders such as bulimia and anorexia nervosa can therefore result in erratic, or absent periods. This is because too few kilojoules are eaten, or too much energy is expended on exercise. Because not enough energy is available, menstruation ceases, and energy is conserved for basic life activities.
Amenorrhoea may be a side effect of certain medications, including sedatives, hormones, chemotherapy drugs, narcotics and antidepressants.
Illnesses that affect the reproductive organs or hormones can result in amenorrhoea – this includes polycystic ovary syndrome (a hormonal disorder that causes high and sustained levels of oestrogen and androgen) and chlamydia (a sexually transmitted disease).
Extended cycle contraceptives such as Lybrel offer women the option of avoiding bleeding altogether. In other words, amenorrhoea can be purposefully induced.
Perimenopause is the time period that leads up to menopause (the cessation of periods). During this period, the body begins to produce less oestrogen and progesterone. Fluctuating hormone levels cause ovulation to become erratic, and the menstrual cycle and intervals between periods become longer.
When menstruation has not occurred for one year, menopause has officially set in. This is a natural part of the ageing process and the beginning of a new life phase. Any bleeding beyond this point could be a symptom of an underlying health problem.