Amenorrhea or absence of periods

Normal menstrual cycle of a woman will range from 21 days to 42 days. Anything beyond this period is considered as abnormal. If periods are delayed or absent in the child bearing age, pregnancy must be considered first. Usually after a miscarriage (abortion), or after childbirth, there may be some delay in recommencing the periods; but, sooner or later, normal periods do set in. What is important is to realize that an ovum (egg) may be released two weeks prior to the first onset of such a period, and conception is possible with this "first egg". If this happens (which is not uncommon), the post abortal (after abortion) or postpartum (after childbirth) amenorrhea will then continue as a pregnancy amenorrhea. In other words, it is not necessary for a person to have a period before conceiving. Thus there is a need for contraception during this time, if pregnancy is to be avoided. It must also be mentioned that it is wrong to think that conception will not occur, as long as the mother is breast feeding. Breast feeding is known to delay the release of the ovum and it may therefore result in irregular periods but it does not altogether prevent the mother becoming pregnant.

It is always better to check presence of urinary hCG before doing anything with a patient with secondary amenorrhea. Patients sometimes seek drug therapy to get their “periods”, when they have amenorrhea. This is not recommended because, it a pregnancy is present, such drugs, which usually contain hormones(and do not usually cause an abortion) may cause abnormalities in the growing fetus.  In countries where abortions are legalized a woman can get the pregnancy terminated. However, in countries where the law does not permit an abortion to be performed except to save the life of the mother, the solution to an unwanted pregnancy would be contraception, which is readily available. It is sad indeed that a young girl, often unmarried, desperate with an unwanted pregnancy, goes to an abortionist to get rid of her pregnancy. These criminal abortions can have disastrous complications such as local abscess formation, sepsis and subfertility in later life. Such sepsis even life threatening.

There are many other causes, other than a pregnancy where amenorrhea may occur. As mentioned before, the menstrual cycle is under the influence of hormones, both from the ovaries and the part of the brain called the hypothalamus and pituitary. Thus stressful situations, such as domestic problems, and school examination tensions, may produce amenorrhea. Other causes of amenorrhea includes, using oral contraceptive pills, contraceptive injections such as Depo -Provera, subdermal implant (Norplant),  drugs such as reserpine(for high blood pressure), digoxin(for heart failure), being on a “crash diet" (sudden and severe reduction of food in an attempt to slim), premature menopause (which may occur around 35 years), trauma (injury) to the womb by repeated scrapes or curettage (D & C, i.e. Dilatation and Curettage), tumors of endocrine (hormone-producing) glands such as disease or tumors of the ovaries and chronic diseases such as tuberculosis.

Medical advice should be sought when there is amenorrhea, unless it is due to a fairly obvious cause such as pregnancy, where there would be other indications.