WOMEN’S BODIES: MENSTRUAL PROBLEMS. SECONDARY AMENORRHOEA
Women can stop menstruating for a variety of reasons. By far the most common is pregnancy. When I was a medical student we were taught ‘all women with secondary amenorrhoea are pregnant until proved otherwise’. A glib statement! But pregnancy should be ruled out first as a cause.
Other reason for secondary amenorrhoea includes disturbance of hypothalamic and pituitary control of ovarian function.
This condition can be caused by any of the following.
• Loss of body fat, due to anorexia nervosa, starvation in famine, or any illness that causes severe wasting. Crash diets can also play havoc with menstrual regularity. If you lose 10 kg or more in a couple of months, periods often stop for a while even if you don’t become underweight. Women athletes who replace most of their body fat with muscle will also stop menstruating. Periods start again when enough fat is restored.
•Profound emotional disturbances, especially bereavement, can shut down the ovarian cycle and stop menstruation. Some women don’t menstruate for months or years after the sudden death of a loved one.
• Change of environment, such as moving house or town, changing to night-shift, or travelling to a different climate can also stop menstruation. Periods usually restart spontaneously when you settle down in the new circumstances. Young women who leave the family home to live in boarding school or nurses’ quarters often stop menstruating for some months. As periods return to women living communally, they will often all menstruate during the same week of the month.
• Pituitary disorders. Overproduction of the pituitary hormone prolactin in a woman who isn’t breast-feeding will suppress the ovaries. Sometimes this is due to a benign (non-cancerous) tumour of the prolactin-producing cells of the pituitary.
• After stopping hormonal contraception, the hypothalamus and pituitary can take a while to ‘switch on’ in a small proportion of women, though menstruation usually returns spontaneously as long as no other cause (such as excessive underweight) exists.
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