Amenorrhoea - when the rule is missing

Menstrual bleeding is a sign of a periodic process that is controlled by many hormones. Disturbances in the regulatory structure can lead to deviations in the strength, duration and regularity of the period. Sometimes she stays completely off. Read here what causes behind a missed period and what you can do about it.

Primary and secondary amenorrhea

The female menstrual cycle occurs at regular intervals between the ages of 13 and 45 and lasts 25-35 days. It serves to provide an egg for reproduction. If there is no fertilization after ovulation, the top layer of the uterine lining is repelled and the period bleeding lasting about 3-7 days begins. The first day of bleeding is the beginning of the new cycle.

This process is based on the same pattern and is controlled by different sex hormones, especially from the brain (FSH, LH) and ovaries (estrogen, progesterone). Menstrual disorders can have mental or physical causes.

  • Primary amenorrhea: No menstrual bleeding occurs until the age of 18 years.
  • Secondary amenorrhea: There was already a normal cycle, then the bleeding stops for at least 3 months.

Causes of amenorrhea

The primary form is almost always based on physical causes. These include congenital chromosomal abnormalities and genital malformations, ovarian dysfunction and hormonal disorders, especially in the diencephalon and pituitary gland.

The Secondary form is often caused by periods of mental or physical stress. These include (job-related) stress, travel, upcoming important decisions or family events. What happens in detail at the hormonal level, is not yet fully elucidated. However, it is believed that such situations can cause nervous system dysfunction that affects hormone regulation.

Especially in younger women can be large weight fluctuations or heavy weight loss such. B. in anorexia lead to failure of the period.

Hormone disorders as a cause

Hormonal disorders and metabolic disorders affect women of all ages. Thus, increased blood levels of male sex hormones lead to a lack of period, an effect that athletes know that take anabolic steroids for muscle growth.

Rarer triggers are hormone-producing tumors in the ovary, severe general conditions and medications, especially hormone preparations and cancer drugs, but also psychotropic drugs and tablets to lower blood pressure. After stopping the pill, it may take several weeks for the cycle to return to normal ("post-pill amenorrhea").

In addition to morbid forms, there is also the physiological, ie normal amenorrhea, which is caused by the hormonal changes during pregnancy and lactation and during and after menopause. Incidentally, even if the menstrual bleeding after birth fails for a few weeks, there is insufficient protection against getting pregnant again, at least if the woman does not breastfeed.

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