The absence of menstruation or amenorrhoea is defined as the absence of one or more menstrual periods. It can occur for various reasons, such as hormonal imbalance or side effects of taking contraceptives and other medications. It can also happen for natural reasons during the ordinary course of life, such as pregnancy or menopause (Mayo Clinic, 2021; NICHD, 2019). In most women with amenorrhoea, the ovaries do not release eggs, so bleeding stops. If this lasts for a long time, problems similar to those associated with menopausal symptoms can occur. These include hot flushes, brown discharge, vaginal dryness, and an increased risk of circulatory disorders and heart disease. These problems occur because the level of oestrogen is low (Pinkerton, 2021). Here are the characteristics of the absence of menstruation in menopause and the symptoms that may accompany it.

Characteristics of the absence of menstruation in menopause

When a woman reaches the stage of puberty, menstruation begins and occurs once a month until the age of 45-50 years, approximately. At about this age, menopause begins, and vaginal bleeding stops. This absence of menstruation occurs due to a lack of oestrogen released from the ovaries, which causes a hormonal imbalance (Gil et al., 2022). Menstrual periods occur regularly during the fertile years, as the ovaries produce sufficient amounts of oestrogen and progesterone. The onset of menopause occurs because, as you get older, your ovaries decrease their production of these hormones until they eventually stop producing them (Pinkerton, 2021). In this way, menstrual periods and ovulation occur less frequently and eventually ceases permanently. The last period can be identified later, after not having menstruation for at least one year (Pinkerton, 2021). Because of these characteristics, the absence of menstruation can be considered a sign of the onset of menopause. It can lead you to experience other symptoms such as (Mayo Clinic, 2021; Gil et al., 2022; NICHD, 2019):

• Alterations to your emotional state.
• Vaginal dryness and pain during sexual intercourse.
• Sleep disturbances.
• Vision changes.
• Decreased sexual desire.
• Excess facial hair, deep voice, and increased muscle size.
• Hair loss.
• Pelvic pain.
• Headache.
• Nipple discharge.
• Significant changes in body weight.
• Problems with bladder control may be accompanied by nocturia (frequent urination at night).

How to check that the absence of menstruation is due to menopause?

If menstrual periods stop during your childbearing years, it may be a form of amenorrhoea. Therefore, it is essential to see your doctor if you have missed three or more periods or have fewer than nine periods a year. Also, if there is a sudden change in the pattern, such as disappearing for months and then becoming regular again (Pinkerton, 2021). It is necessary to rule out pregnancy and check whether it is the onset of menopause in these cases. The general protocol is to perform a physical examination to find out your menstrual history, which may include a vaginal/abdominal ultrasound, as well as a hormone test to assess oestrogen deficiency (Gil et al., 2022).

Diagnostic tests that your doctor can send you

To check whether this may be a sign that menopause has arrived, there are diagnostic tests that your doctor can send you to rule out other causes. These include (Mayo Clinic, 2021):

• Diagnostic thyroid function test to determine if the thyroid is functioning correctly.
• Ovarian function test that measures whether the ovaries are functioning properly.
• Prolactin test, a hormone that stimulates breast milk production. Low levels of this hormone may signify a pituitary gland tumour.
• Determination of male hormones in the blood if you have more facial hair and a deeper voice.

The absence of menstruation during menopause is due to the hormonal changes you experience at this stage. Periods are interrupted mainly by low or no oestrogen levels. It is important to see a doctor to check that it is the onset of menopause when this happens. With this, you can treat your symptoms early and minimise their impact.

References

Gil, L., Barranquero, M., De la Fuente, P., and Fabra, P. (2022, 16 February). Absence of menstruation or amenorrhoea: causes and treatment. Assisted Reproduction ORG. https://www.reproduccionasistida.org/amenorrea/

Eunice Kennedy Shriver National Institute of Child Health and Human Development . (2019, 26 June). Amenorrhoea. https://espanol.nichd.nih.gov/salud/temas/amenorrhea

Mayo Clinic. (2021, 29 July). Amenorrhoea. https://www.mayoclinic.org/es-es/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299

Mayo Clinic. (2021). Urinary incontinence. https://www.mayoclinic.org/es-es/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808

Pinkerton, J. (2021). Absence of menstrual periods. MSD Manual. https://www.msdmanuals.com/es/hogar/salud-femenina/trastornos-menstruales-y-sangrados-vaginales-an%C3%B3malos/ausencia-de-periodos-menstruales

Pinkerton, J. (2021). Menopause. MSD Manual. https://www.msdmanuals.com/es/hogar/salud-femenina/menopausia/menopausia