Amenorrhea: When Your Period Doesn't Return for a Year

Menstruation has not occurred for nearly a year?

Hello: I have already tried consulting many Western and Chinese medicine practitioners, and I have been taking Chinese herbal medicine for nearly two months.
At the end of February this year, I received two injections to induce menstruation from a gynecologist, but although I have a noticeable contraction sensation in my ovaries, my period still hasn't come.
Just last week, I went to Chimei Hospital again and took medication to induce menstruation.
The doctor said my period would come 3 to 4 days after taking the medication, but I only experienced an increase in discharge, and now it has been 6 days without my period.
Last year, I went to Chimei for the same issue and took the inducing medication (hormonal regulators) three times (with a one-week interval) before my period returned, but it stopped again after I finished the medication.
Blood tests and ultrasounds have all come back normal.
I am very anxious, my temper has become quite bad, and I often have insomnia.
What should I do? Who should I seek help from?
P.S.
1.
I started experiencing menstrual irregularities after losing 15 kilograms over a year and a half through exercise and dieting.
I am currently 161 cm tall and weigh 43.5 kg.
2.
I have not engaged in sexual intercourse and am not pregnant.

Kunrao de nvsheng, 20~29 year old female. Ask Date: 2002/03/21

Dr. Wu Zongcheng reply Obstetrics and Gynecology

Excessive exercise and weight loss can affect ovarian function, leading to missed periods.
We recommend that you come to our clinic for a comprehensive endocrine evaluation to identify which aspect of your ovarian endocrine system is malfunctioning.
Targeted treatment based on the underlying cause will be effective.

Reply Date: 2002/03/21

More Info

Amenorrhea, or the absence of menstruation for an extended period, can be a distressing condition, especially when it persists for a year or more. Your situation, where you have tried various treatments without success, is understandably frustrating. Let's break down the potential causes and management strategies for amenorrhea, particularly in the context of your experiences.

Understanding Amenorrhea
Amenorrhea can be classified into two types: primary and secondary. Primary amenorrhea refers to the absence of menstruation by age 15 in girls who have not developed secondary sexual characteristics, while secondary amenorrhea is defined as the cessation of menstruation for three cycles or more in women who have previously menstruated. In your case, it seems you are experiencing secondary amenorrhea.

Several factors can contribute to secondary amenorrhea, including:
1. Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or hyperprolactinemia can disrupt the hormonal signals necessary for menstruation.

2. Stress and Lifestyle Factors: Significant weight loss, excessive exercise, and psychological stress can all lead to amenorrhea. Your mention of losing 15 kilograms through diet and exercise may have contributed to this condition. The body sometimes responds to perceived stress (including physical stress from weight loss or excessive exercise) by shutting down reproductive functions.

3. Medical Conditions: Other underlying medical issues, such as chronic illnesses or hormonal disorders, can also lead to amenorrhea.

4. Medications: Certain medications, including hormonal treatments, can affect menstrual cycles.

Management Strategies
Given your situation, here are some steps you might consider:
1. Consult a Specialist: Since you have already seen both Western and traditional Chinese medicine practitioners, it may be beneficial to consult a reproductive endocrinologist or a gynecologist specializing in menstrual disorders. They can provide a comprehensive evaluation, including blood tests to check hormone levels and possibly imaging studies to assess ovarian function.

2. Lifestyle Modifications: If your amenorrhea is related to weight loss or exercise, consider gradually increasing your caloric intake and reducing the intensity of your workouts. A balanced diet that supports your energy needs is crucial. Aim for a healthy weight that is sustainable for you, as being underweight can significantly impact your menstrual cycle.

3. Stress Management: Since you mentioned experiencing increased irritability and insomnia, addressing stress through relaxation techniques, mindfulness, or therapy may help. Psychological stress can have a profound impact on hormonal balance.

4. Hormonal Treatments: If hormonal imbalances are identified, your doctor may recommend hormonal treatments to help regulate your menstrual cycle. This could include birth control pills or other hormone therapies that can help restore regular menstruation.

5. Regular Monitoring: Keep track of any changes in your symptoms, including mood swings, sleep patterns, and any physical changes. This information can be valuable for your healthcare provider in determining the best course of action.

6. Patience and Support: Understand that restoring menstrual regularity can take time, especially after significant lifestyle changes. Seeking support from friends, family, or support groups can also be beneficial as you navigate this challenging period.

Conclusion
Amenorrhea can be a complex condition influenced by various factors, including lifestyle, hormonal health, and psychological well-being. Given your history and the treatments you've tried, it is essential to work closely with a healthcare provider who can guide you through the next steps. They can help identify any underlying issues and develop a tailored treatment plan that addresses your specific needs. Remember, you are not alone in this journey, and with the right support and management, it is possible to restore your menstrual health.

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