While menstruating can be a difficult, and sometimes inconvenient, monthly experience, it is still concerning when a menstrual cycle is missed. Outside of pregnancy, perimenopause/menopause, or some hormonal intrauterine devices (IUD), it is not normal to have infrequent or absent menstrual cycles.

What is the difference between primary & secondary amenorrhea?

Amenorrhea is the medical term for lack of menstrual cycle. Primary amenorrhea is lack of onset of menstruation by the age of fifteen. Secondary amenorrhea, which will be the subject of this article, is lack of menstruation for three months in someone with a previously regular cycle or six months in someone with an irregular cycle.

What is oligomenorrhea?

Oligomenorrhea is the medical term for infrequent menstruation, which is defined as fewer than nine menstrual cycles in one year. While slightly different, secondary amenorrhea and oligomenorrhea are explored in the same way, and could have the same underlying cause.

What lab tests do naturopathic doctors order for infrequent or absent menstrual cycles? How do these tests relate to the underlying cause of my menstrual irregularities?

There are many different reasons why amenorrhea and oligomenorrhea occur, and while this article will not describe all possibilities, the bottom line is that laboratory testing is required to determine the cause. Some tests your health care provider should request include: a pregnancy test, follicle stimulating hormone (FSH), estradiol, thyroid stimulating hormone (TSH), prolactin, and testosterone.

FSH is a hormone released by the brain that governs ovarian function.

Estradiol is a form of estrogen, and when measured in conjunction with other tests, can help uncover what is causing the lack of menstruation. In addition, low levels are associated with loss of bone mineral density and increased risk of fractures and osteoporosis later in life.

TSH is a measure of thyroid health, and thyroid disorders, both hypothyroidism and hyperthyroidism, are associated with menstrual cycle changes.

Prolactin is a hormone released by the pituitary gland in the brain, and elevated levels can cause amenorrhea, and require further investigation.

Testosterone belongs to the group of hormones known as androgens, which are well known for their role in the development of male sex characteristics. Testosterone is also normally found in females, but high levels in the presence of amenorrhea are likely due to polycystic ovary syndrome (PCOS).

What lifestyle factors contribute to irregular or absent menstrual cycles?

Outside of the previously mentioned lab tests and underlying conditions, there are some other causes of amenorrhea that are important to consider. The negative effects of stress on the menstrual cycle should not be underestimated, and prolonged periods of stress can certainly cause menstrual cycle irregularity. Over exercise or strenuous exercise can also cause a lack of menstruation, possibly due to not eating enough calories to adequately compensate for the loss through activity. This is especially likely in those with low body fat. Similarly, eating disorders are another common cause of amenorrhea. In fact, diets that are low in fat, cholesterol, and calories can cause amenorrhea because cholesterol is needed to make hormones. In addition to running lab tests, it is also important to consider diet, stress, and activity level.

My goal as a naturopathic doctor is to is to empower people to become educated about their health, and advocate for themselves when necessary.

It is important to work with health care providers that are willing to figure out the underlying cause, and offer treatments that address it. If you are experiencing prolonged amounts of time between periods, it is time to see a health care provider.

To book an appointment with one of our knowledgable Naturopaths at Juniper Family Health please call 778-265-8340 or book online here.

References

Hudson, T. (2008). Women’s Encyclopedia of Natural Medicine. McGraw-Hill.

Welt C. K. et al (2019). Evaluation and management of secondary amenorrhea. Up To Date.