Long Absence of Menstruation and Stomach Pain: the Connection

Prolonged absence of menstruation and stomach pain?

I will turn 18 at the end of the year.
Since my first menstrual period (around sixth grade), my cycles have always been irregular, but I know that it's common at a young age.
However, I haven't had my period for a long time, starting from early last year.
I visited a gynecologist in September and again in February of this year.
During the September visit, the doctor performed an ultrasound on my uterus and found no issues.
Both times, the doctor prescribed me medication to induce my period, and I did get my period that month, but it hasn't returned since.
So now, I haven't had my period for 5 months.
I have no sexual experience, and my overall health has been good; I never experienced pain during my periods before.
Recently (for about the last 3-4 months), I've been experiencing frequent stomach pain, which I never had before.
Could these two issues be related?

Judy, 10~19 year old female. Ask Date: 2015/07/18

Dr. Lin Manying reply Obstetrics and Gynecology

1.
Secondary amenorrhea (absence of menstruation for more than three months) requires a visit to the outpatient clinic for evaluation to determine the underlying cause and appropriate management, rather than simply prescribing menstrual induction medication.

2.
For abdominal pain, one should first consult a gastroenterologist for medical evaluation, along with an obstetric and gynecological ultrasound to check for any related issues.

Reply Date: 2015/07/18

More Info

The connection between long absence of menstruation (amenorrhea) and stomach pain can be complex and multifaceted. It is important to understand that while these two symptoms may seem unrelated, they can indeed be linked through various physiological and psychological mechanisms.

Firstly, amenorrhea can be caused by a variety of factors, including hormonal imbalances, stress, significant weight changes, excessive exercise, and underlying medical conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders. In your case, since you have experienced irregular periods since your early teens and have not had a menstrual cycle for five months, it would be prudent to consider these factors. Hormonal imbalances, particularly involving estrogen and progesterone, can affect not only menstrual cycles but also gastrointestinal function.
Stress is another significant factor that can impact both menstrual cycles and gastrointestinal health. The body’s stress response can lead to increased levels of cortisol, which may disrupt the normal functioning of the hypothalamus, pituitary gland, and ovaries, leading to irregular or absent periods. Additionally, stress can exacerbate gastrointestinal issues, leading to symptoms such as stomach pain, bloating, and discomfort.
Regarding your stomach pain, it is essential to consider the possibility of functional gastrointestinal disorders, such as functional dyspepsia or irritable bowel syndrome (IBS), which can manifest as stomach pain and discomfort without any identifiable structural abnormalities. These conditions can be influenced by stress, diet, and lifestyle factors.
Moreover, hormonal fluctuations can also influence gastrointestinal motility and sensitivity. For instance, during the menstrual cycle, some individuals may experience gastrointestinal symptoms due to hormonal changes. Although you mentioned that you did not experience pain during your periods in the past, the absence of menstruation and the associated hormonal changes could potentially lead to new gastrointestinal symptoms.

Given that you have been prescribed medication to induce menstruation, it is crucial to follow up with your healthcare provider to explore the underlying causes of your amenorrhea further. They may recommend additional tests, such as blood tests to check hormone levels, thyroid function tests, or imaging studies to rule out any anatomical issues.
In the meantime, it may be beneficial to keep a symptom diary to track your menstrual cycles, stomach pain episodes, dietary habits, and stress levels. This information can provide valuable insights for your healthcare provider and help identify any patterns or triggers.

In summary, while the absence of menstruation and stomach pain may seem like two separate issues, they can be interconnected through hormonal, psychological, and physiological pathways. It is essential to work closely with your healthcare provider to investigate these symptoms further and develop a comprehensive treatment plan that addresses both your menstrual health and gastrointestinal concerns.

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