American Medical Association Family Medical Guide - American Medical Association [565]
Hormone activity can be disrupted by a number of factors, including severe stress, rapid weight loss, or a medical condition, or from taking some medications. Women who stop taking oral contraceptives may experience secondary amenorrhea for a few months. Sometimes secondary amenorrhea results when a disorder of the hypothalamus, pituitary gland, or ovaries disrupts the hormone-signaling system that triggers ovulation.
Normally, a balance exists between estrogen and progesterone (the major female sex hormones). If a hormone imbalance is causing the amenorrhea, a woman can have hormone-related problems. For example, failure to have periods for a number of months can indicate a lack of estrogen, which can lead to bone loss (osteoporosis; see page 989). In some cases, a hormone imbalance results from obesity, a condition called polycystic ovarian syndrome (see page 865), high blood pressure, or diabetes, any of which can block the body’s production of progesterone. Without progesterone, increased estrogen levels can raise the risk of a precancerous condition called endometrial hyperplasia (see page 868) or endometrial cancer (see page 869). In rare cases, amenorrhea can be a sign of a more serious disorder, such as Cushing’s syndrome (see page 898).
Diagnosis
If your periods are fairly regular and your period is delayed 2 weeks or more, pregnancy is the most likely cause. A doctor will first do a pregnancy test to determine if that is the cause. If you are not pregnant and are otherwise healthy, your doctor will probably tell you to wait for a few months to see if your periods start again on their own. If you do not have a period for 6 months, your doctor may order diagnostic tests to check for an underlying disorder, such as hypothyroidism (see page 903). The doctor may need to check your hormone levels to make sure you are producing estrogen and that you have not gone into premature menopause.
Treatment
If you are not having periods, your doctor will treat the underlying cause. If you are not producing estrogen, your doctor may prescribe hormone therapy (see page 853). Women who don’t have regular periods may have difficulty getting pregnant. If you want to become pregnant, the doctor may prescribe a fertility drug (see page 499) to restart ovulation. Women who have the eating disorder anorexia (see page 726), who are very thin, or who exercise excessively or do vigorous athletic training on a regular basis can have either a delayed onset of menstruation or cessation of their periods (see above). This condition usually indicates that they are not consuming enough calories to maintain a normal weight or proportion of body fat, which reduces estrogen production.
The Female Athlete Triad
The benefits of physical activity almost always outweigh the risks. But some women who train intensively for athletic competition and do not consume enough calories to compensate for their increased activity level risk developing a condition known as the female athlete triad. This disorder is a cluster of three conditions—eating disorders (see page 724), lack of periods, and the bone-thinning disorder osteoporosis (see page 989)—that can occur together in women who engage in intense athletic exercise or training.
The prevalence of the female athlete triad is difficult to assess because many women with an eating disorder are secretive about their eating habits. Among the contributing factors are pressure by coaches and parents to win at all costs, frequent weigh-ins that penalize athletes for weight gain, and society’s preference for a thin body. The girls and women most at risk of developing the condition are those in