Amenorrhea is the absence of menstrual bleeding which under normal circumstances occurs during puberty, pregnancy and menopause. This disorder is only prevalent in women of reproductive age. During the reproductive phase, diagnosis of amenorrhea is the said to be the first sign of pregnancy. In cases where pregnancy is ruled out, it is important to determine the other causes of amenorrhea. There are two forms of amenorrhea,

• Primary amenorrhea- this is a conditioned which is limited to young women between the age of 12 and 18. It involves absence of secondary sexual characters such as development of breasts or absence of menstrual cycle till the age of 16, despite development of breasts. It can also be described as delayed menarche.
• Secondary amenorrhea- this is sudden cessation of menstrual cycle despite having regular menstrual cycle for months or years.

Causes of Amenorrhea-

• Pregnancy- this is the most common cause of absence of periods and for centuries has been used as the diagnostic test to detect pregnancy.
• Contraception- women who are on pills may not be able to have their normal menstrual cycle as the pill contents can play havoc with the ovulation and menstruation. External contraceptive devices can also disrupt the cycle as they interfere with the hormonal balance.
• Breast feeding- in some women who are breast feeding, ovulation may occur without the presence of menstrual cycle.
• Mental stress- emotional turbulence can temporarily hamper the menstrual cycle. This occurs because the part of the brain that controls menstrual cycle gets affected during stress. Most patients report normal occurrence of menstrual cycle after the stress decreases.
• Medication- as a result of certain medication, the menstrual cycle can get affected. This includes antidepressants, antipsychotic and chemotherapy.
• Hormonal imbalance- a common cause of hormonal imbalance is PCO’s. During this phase, there is high level estrogen and androgens (male hormone) which causes menstrual cycle to get delayed.
• Pituitary- tumor (benign) in the pituitary can cause an increase in the prolactin level. Excess of prolactin can interfere with the menstrual cycle.
• Genetic- in some cases the women may be suffering from chromosomal abnormality which can cause untimely depletion of the eggs and follicles and ultimately interferes with the ovulation and menstruation.
• Fetal abnormality- in some cases, during the fetal abnormality, the female may be born without the vital reproductive organ which may lead to absence of uterus, cervix or vagina. This can lead to permanent absence of menstrual cycle.
• Structural abnormality of the vagina- in some cases, there may be an obstruction in the vagina which due to which the blood may not be able to flow out through the vagina. Due to this, there may be a mass that collects in the uterus.
• Rigorous exercising –women who exercise vigorously also experience abnormal menstrual cycle, with a few continuous months where they may not menstruate.
• Severe weight loss- women who go on severe diets and exercises may have delayed or absent menstrual cycle due to abnormal hormonal imbalance.

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