Conditions and Management

Amenorrhea is a name given to the absence of menstruation during a woman’s reproductive years. The term simply signifies that a woman has not been getting her period despite being between the ages of puberty and menopause.

Although amenorrhea isn’t a disease and does not signify a person is infertile, it can indicate that a health problem needs to be addressed. Amenorrhea is a symptom rather than an illness, and your doctor will try to find out why you are not menstruating.

Menstruation begins for women at puberty and then occurs once a month until approximately age 50, at which point it stops as menopause begins. Menstruation also stops during pregnancy and may even disappear while a woman is breastfeeding. However, if menstruation does not occur at a time when you expect it to, it is considered amenorrhea.

Types Of Amenorrhea

The main symptom of all types of amenorrhea is an absent period, but there are two main categories of amenorrhea that are used to explain causes and potential solutions.

Primary Amenorrhea

If a woman’s periods do not start during puberty, this is considered primary amenorrhea. The National Institutes of Health recommend that women seek medical help if they have not had their first period by age 16. It is important to note that primary amenorrhea is extremely rare, affecting fewer than 0.1% of American women. (1)

Most girls will get their first period sometime between 10 and 15, with the average age being 12. However, each girl’s body operates on its own schedule, and there is no “right” age for getting a first period.

Causes Of Primary Amenorrhea

One common reason a girl may not have her first period by age 16 is a family history of delayed menstruation. However, there could be a genetic condition that stops the ovaries from working properly, such as androgen insensitivity syndrome, Turner syndrome, or a malformation of the reproductive organs. A structural problem that is present from birth may also be at play; many times these can be corrected with surgery.

Diagnosis Of Primary Amenorrhea

If a girl does not get her first period by 16, a doctor may ask for her family history and conduct tests that measure her levels of certain hormones. A physical examination will also be performed to ensure that there are not any physical problems preventing menstruation from occurring.

Secondary Amenorrhea

Secondary amenorrhea is when a woman who had periods in the past suddenly finds that menstruation stops without explanation. If a woman who is not pregnant or breastfeeding finds that her once-regular periods stop occurring for three months or longer–six months or longer in the case of a woman who had irregular periods–there could be a problem. Missing a period once does not usually signify a health problem, although a pregnancy test is advised in this case.

Causes Of Secondary Amenorrhea

The main causes of secondary amenorrhea include health conditions, stress, weight loss, and medications.

Health Conditions

Long-term illnesses such as premature ovarian failure, thalamic pituitary problems, and polycystic ovary syndrome, or PCOS, could lead to secondary amenorrhea. In addition, an underactive thyroid or pituitary problems can cause hormonal imbalances that lead to menstrual issues.

Stress

Going through severe emotional upheaval or an extreme amount of stress may cause a woman’s periods to stop temporarily.

Weight Loss And Exercise

Serious weight loss, whether it stems from an eating disorder or a physical illness, can cause a woman’s period to stop. In addition, extremely stringent exercise regimens could lead to secondary amenorrhea. The condition is quite common among women who are professional ballet dancers and competitive long-distance runners, for example.

Low Body Mass Index

When a woman’s body mass index drops below 19, her risk of developing secondary amenorrhea increases significantly.

Medications

Certain medications may cause periods to stop. These include progesterone-only contraceptives, antipsychotics, antidepressants, blood pressure drugs, cancer chemotherapy, and allergy medications.

Diagnosis Of Secondary Amenorrhea

When a woman reports that she has stopped menstruating after having periods in the past, her doctor may ask her if pregnancy is possible in addition to inquiring about any recent weight loss or weight gain, her exercise routine, the regularity of her menstrual cycle in the past, and the age at which she began getting periods.

Depending on the potential cause, the doctor may order other tests, such as hormone tests, thyroid function tests, or pregnancy tests, as well as imaging tests as needed.

With secondary amenorrhea, addressing the underlying cause may be enough to restore normal menstruation. For example, a person who has been exercising excessively may wish to revise her regimen to help stabilize her monthly cycle, while those who have stopped getting periods due to stress may find relief from counseling.

Get In Touch With Raleigh Gynecology & Wellness

If you have concerns about your cycle, get in touch with the friendly team of health care professionals at Raleigh Gynecology & Wellness. We are experienced in addressing menstrual disorders, and our focus is on ensuring every patient feels comfortable and informed.

As an adult woman, routine Pap smear should be part of your healthcare routine. It is the best way for your doctor to detect signs of serious health conditions in your cervix, such as precancerous cells, or even cancer.

What Exactly Is A Pap Smear?

A Papanicolaou test, also called a “Pap” smear or Pap test, is a procedure that is performed in your gynecologist’s office, usually as part of a pelvic examination. A Pap smear tests your cervix for cervical cancer and precancerous cells. Your cervix is located at the lower, narrow end of your uterus at the top of your vagina.

To have a Pap test taken, you will be positioned lying down on the examining table to enable your doctor to access your cervix through your vaginal canal. The doctor gently slides a special tool called a speculum into your vagina to hold open the walls of the vaginal canal. Next, your doctor goes in with a tiny spatula or brush and wipes your cervix. This instrument takes some cervical cell samples that are sent to a lab to be tested.

Why Is A Pap Smear Necessary at All?

A Pap smear is the best way to screen for cervical cancer and other abnormal cells on your cervix. It is usually done in conjunction with your annual well woman exam.

When Should You Begin Having Pap Smears?

You should begin having Pap smears when you turn 21. Your doctor can give you a recommendation as to when you should begin Pap testing and how often you should have the test.

Why Is It A Good Idea To Have A Pap Smear Annually?

Annual Pap testing is the best way to detect cervical cancer early. Cervical cancer can be a deadly form of cancer. Early detection gives you a greater chance at a cure. Most women between 21 and 65 should have a Pap smear at least once every three years.

Even if no cancer cells are present, having routinePap smears can detect changes in your cervical cells that suggest cancer may develop in the future. Finding any abnormal cells early helps to prevent the development of cervical cancer.

In some cases testing for Human Papilloma Virus (HPV) is done in conjunction with the pap test. If you are one of many women who has specific risk factors, you should discuss with your doctor whether having Pap testing done more frequently is advisable.

Common risk factors include:

• Prior diagnosis of cervical cancer or precancerous cells.
• HIV infection.
• Weakened immune system due to organ transplant, chemotherapy, or chronic corticosteroid use.
• History of smoking.

Another reason to have Pap tests done regularly is to mitigate risks caused by false-negative tests. Pap tests are very reliable, but on rare occasions a patient can get false-negative results. A false-negative test means that the results show no abnormalities, but in fact there are changes in the cervical cells.

This can be caused by inadequate cell collection, insufficient amounts of abnormal cells to be identified in the test, or inflammation or blood obscured collection of abnormal cells. Because cervical cancer cells usually grow slowly, your next annual Pap test is likely to identify cell abnormalities early enough to treat it.

Are There Health Risks Associated With Having A Pap Smear Done?

A Pap smear presents very low health risks to the patient. Occasionally, you will feel discomfort, but no pain during the procedure. To minimize your discomfort, you should schedule your Pap test when you are not menstruating.

When Do You No Longer Need To Do Pap Testing?

You should continue getting Pap testing performed for as long as you are sexually active. You may no longer need to do so under the following conditions, but you should discuss your circumstances with your doctor:

1. You have had a total hysterectomy. A total hysterectomy means you have had your uterus and your cervix surgically removed for reasons not based on the presence of cancer or cancerous cells. If your hysterectomy was performed for a noncancerous condition, such as uterine fibroids, you may be able to discontinue routine Pap smears.
2. You are 65 or older. Some doctors suggest that routine Pap smears are not necessary for older women as long as their prior tests for cervical cancer have been negative.

Contact Raleigh Gynecology and Wellness to Schedule Your Pap Smear

If you need more information about Pap testing, consult with the experts at Raleigh Gynecology and Wellness. They are available to answer your questions about pap smears, pelvic examinations and any other issue pertaining to women’s reproductive health and wellness. Contact them to schedule an appointment.

No two women will have the same experience when it comes to their period, but there is a range of what is considered normal in terms of cycle length, regularity, and flow.

Anything that falls outside of this range, along with any sudden or dramatic changes in your typical menstrual cycle, may signify a menstrual disorder.

Causes of Menstrual Disorders Irregularities

Tracking your period can be incredibly helpful, especially if you suspect something is amiss. A period log with dates and flow levels also can assist medical professionals to determine what may be causing your issues. However, it is important to seek help right away if you are experiencing excessive bleeding or severe pain.

The causes of menstrual irregularities and disorders vary and many of them are treatable. Here is a look at some of the most common issues behind these problems.

Perimenopause

Many women in their 40s experience perimenopause, which is the transitional phase that occurs before you go into full menopause. However, it also may affect younger women.

The signs of perimenopause can last for several years and often begin with changes to your menstrual cycle. This is because your estrogen levels tend to fluctuate during perimenopause, causing your cycles to get shorter or longer. If your menstrual disorder is accompanied by symptoms such as hot flashes, night sweats, difficulty sleeping, and mood changes, it could indicate perimenopause.

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome, or PCOS, is a condition that impacts a woman’s hormone levels. This imbalance can cause you to skip periods and experience heavy bleeding when you do get your period.

It is important to report these issues to your healthcare provider as PCOS also may lead to infertility, obesity, male pattern baldness, and excess body or facial hair. Additionally, itcan contribute to serious problems like heart disease and diabetes. However, a doctor can help you to correct this hormone imbalance and improve your symptoms.

Endometriosis

When the tissue that normally lines your uterus begins to grow outside of the uterus instead, it leads to a condition known as endometriosis. This can cause very painful menstrual cramps that may be debilitating, in addition to prolonged periods with heavy bleeding and bleeding in between periods. Although endometriosis does not have a cure, it is possible to manage symptoms with medication or hormone therapy.

Thyroid Issues

Thyroid disorders are a common cause of menstrual irregularities. For example, hypothyroidism, or an underactive thyroid, may cause women to experience increased cramping and heavier, longer periods. Fatigue, weight gain, and sensitivity to cold are other symptoms of thyroid issues.

Having high levels of thyroid hormones in the form of hyperthyroidism can lead to lighter and shorter periods. This also might be accompanied by heart palpitations, anxiety, and sudden weight loss.

Hormonal Birth Control

If you are experiencing changes in menstruation, it is important to take a look at your birth control method to see if it could be causing the issue. Some hormonal birth control pills may cause irregular bleeding, spotting between periods, and later periods. Intrauterine devices, the Paragard non-hormonal IUD, may cause heavier bleeding.

Uterine Fibroids

In some women, muscular tumors known as fibroids develop within the wall of the uterus. Although this may sound scary, most fibroids are not cancerous. Nevertheless, they can lead to painful periods that are heavy enough to cause anemia. Iron supplements are often recommended for women with menstrual disorders that lead to anemia.

Weight Loss And Eating Disorders

Women who are underweight, have recently lost a significant amount of weight without trying, or have an eating disorder may find that their period stops entirely despite not being pregnant. This is because consuming insufficient calories interferes with the production of hormones your body needs to ovulate. Addressing eating disorders and reaching a healthier weight can alleviate these problems.

Too Much Exercise

There is no question that exercise is good for your health, but exercising excessively and too intensely can interfere with the hormones that are responsible for menstruation. Many female athletes and those who are taking part in intensive physical training develop amenorrhea, which is a condition that occurs when your periods stop or are missed frequently. In these cases, reducing training or increasing calorie intake can help periods return to normal.

Medications

There’s a broad range of medications that can interfere with a woman’s menstrual cycle and cause menstrual disorders. These include blood thinners, epilepsy drugs, chemotherapy drugs, aspirin and ibuprofen, antidepressants, thyroid medications, and hormone replacement therapy.

If you are experiencing a menstrual disorder, it is important to let your doctor know all of the medications you are taking so they can explore any potential connections. It is not a good idea to suddenly stop taking these medications, but a healthcare professional can help you to find alternatives that are less likely to cause menstrual disorders.

Talk To Your Doctor About Menstrual Disorders

Menstrual disorders can be caused by a range of issues, many of which can be corrected with medical treatment. If you are experiencing a sudden change in your cycle, spotting between periods, excessive bleeding, or your period stops for more than three months and you are not pregnant, it is important to contact your doctor right away.

Get In Touch With Raleigh Gynecology & Wellness

Although menstrual disorders can be frustrating, many of them are highly treatable. The friendly team of healthcare professionals at Raleigh Gynecology & Wellness can help you understand what is causing your menstrual disorder and recommend treatments that can provide much-needed relief.

Menstruation is a cycle that involves the monthly shedding of the lining of the uterus, known as the endometrium, in the absence of pregnancy. Although this definition implies that menstruation comes with a certain sense of regularity and may be quite predictable for some women, it is a highly individual experience that not only varies widely from woman to woman, but also can be experienced differently from month-to-month. Here are some of the most common menstrual disorders.

Common Menstrual Disorders

Discomfort before and during your period is not unusual, and cycles that vary in length by a few days are not a cause for concern. However, some women develop menstrual disorders that may require treatment to alleviate symptoms. Here is a look at some of the most common types of menstrual disorders.

Premenstrual Syndrome (PMS)

Premenstrual syndrome, or PMS, is an extremely common disorder with the American College of Obstetricians and Gynecologists estimating that almost 85 percent of women experience at least one of its symptoms during their reproductive years. However, around 5 percent of women will experience symptoms that are so severe that it is disabling.

The Symptoms of PMS

Each woman experiences PMS differently, but some of the most common complaints include:

• Fluid retention (such as swelling of the feet, ankles, and fingers)
• Psychological symptoms (especially anxiety, irritability, and depression)
• Skin problems, such as acne
• Bloating
• Gastrointestinal symptoms
• Appetite changes
• Breast tenderness
• Decreased libido
• Headache
• Reduced coordination
• Infections
• Fainting

Alleviating PMS

For many women, lifestyle modifications can help alleviate PMS symptoms. Exercising regularly and getting adequate sleep are great approaches that also can improve your overall health. In addition, consuming a balanced diet rich in vegetables, fruits, and whole grains while limiting salt, sugar, alcohol, and caffeine can help eliminate or reduce the severity of your PMS symptoms.

Amenorrhea

Amenorrhea is the absence of a menstrual period for longer than three monthly menstrual cycles.

It may be primary amenorrhea, which means that a woman never begins menstruating during puberty, or secondary amenorrhea, which occurs when what were once regular menstrual periods become increasingly abnormal or absent.

Causes Of Amenorrhea

It is important to note that amenorrhea may occur as part of the normal course of a woman’s life. Pregnancy is one of the most common reasons regular menstruation suddenly stops, but breastfeeding also may cause a woman’s period to be absent for an extended period. Menopause is another common cause of amenorrhea that is considered a normal part of aging.

However, it also could be caused by certain medications, behaviors, or medical problems, including obesity, eating disorders, excessive exercise, thyroid issues, ovulation irregularities , or an anatomical abnormality.

If you have missed three consecutive menstrual periods, you should visit a doctor for advice as early diagnosis and treatment are essential. Women who have not had their first period by age 16 also are advised to see a healthcare professional to ensure there are no issues preventing menstruation from occurring.

Menorrhagia

A common type of abnormal uterine bleeding is menorrhagia, which is characterized by prolonged, heavy menstrual bleeding that may be severe enough to disrupt your daily activities.

It is considered menorrhagia when a woman soaks through sanitary napkins or tampons to the point that they must be changed every hour or more often and/or a period lasts longer than seven days.

Menorrhagia may be caused by a hormonal imbalance, uterine fibroids, an abnormal pregnancy, pelvic infections or growths, bleeding disorders, pelvic inflammatory disease, some types of birth control devices, high levels of prostaglandins or endothelins, or other medical issues.

Other types of abnormal uterine bleeding include:

• Postmenopausal bleeding (bleeding that occurs more than a year after the last normal period at menopause)
• Oligomenorrhea (light or infrequent menstrual cycles)
• Metrorrhagia (nonmenstrual bleeding, such as bleeding that occurs between periods)
• Polymenorrhea (menstruating too frequently)

Dysmenorrhea

Dysmenorrhea is a condition marked by severe and frequent menstrual cramps and pain. Primary dysmenorrhea occurs when a chemical imbalance in a woman’s body causes abnormal uterine contractions. Other medical conditions could cause secondary dysmenorrhea, such as an infection, uterine fibroids, pelvic cavity growths, or pelvic inflammatory disease. In addition, an abnormal pregnancy, such as an ectopic pregnancy or a miscarriage, could cause dysmenorrhea.

Symptoms Of Dysmenorrhea

Excessive menstrual cramping and pain are the hallmarks of dysmenorrhea, but other symptoms include:

• Lower abdominal pain and cramping
• Lower back pain
• Pain that radiates down the legs
• Vomiting or nausea
• Diarrhea
• Weakness and fatigue
• Headaches
• Fainting

How Can Menstrual Disorders Be Treated?

The specific treatments for a menstrual disorder will depend on your health, medical history, age, condition, symptoms, and the causes of the disorder.

There are lots of options available, including dietary modifications, oral contraceptives, hormone supplements, antidepressants, regular exercise, prostaglandin inhibitors, and surgery. It is essential to visit a healthcare professional to diagnose the problem and devise a treatment plan.

Reach Out To Raleigh Gynecology & Wellness

If you are experiencing any symptoms of menstrual disorders or have questions or concerns about your cycle, get in touch with the friendly team of medical professionals at Raleigh Gynecology & Wellness to learn more about our services and schedule an appointment.

Most people instinctively want to see a doctor when they are experiencing unusual symptoms, such as bleeding between periods, pain in the pelvis region or abnormal vaginal discharge. While visiting an obstetrician-gynecologist (OB-GYN) is wise when experiencing complex or ongoing conditions, many common gynecologic problems can be diagnosed and treated by a nurse practitioner (NP).

What Is a Nurse Practitioner?

A nurse practitioner is a type of healthcare professional that offers a wide range of services, including primary care, acute care and specialty care services. The role of an NP can change based on his or her environment. In a hospital setting, a NP may help care for sick patients who have been admitted to the hospital, have suffered injuries or are undergoing surgical procedures.

NPs are also permitted to order diagnostic and lab tests to help in the diagnosis process. They may also debride wounds, put casts on injuries or assist in intubation. NPs have the knowledge and skill needed to diagnose and treat both short-term and long-term conditions. They may also specialize in specific practice areas, such as pediatrics, orthopedics, psychiatry, gerontology or oncology.

To become a NP, a person must complete a Bachelor’s of Science in Nursing (BSN) program, as well as a Master’s of Science in Nursing (MSN) degree or a Doctor of Nursing Practice (DNP) degree. Many states require nurse practitioners to obtain their license before they can practice in their state. Requirements can vary by location, but NPs are often required to renew their license on a regular basis.

What Is the Difference Between a NP and A Doctor?

There are many similarities between NPs and doctors, but these two professions also have distinct differences. The first difference is the education and training received by each group. Doctors generally go to school and train longer than NPs. According to the American Academy of Family Physicians, it takes an average of 11 post-secondary years of training and education to become a MD or a DO. In comparison, it takes about six to eight years to become a NP.

There are also some similarities and differences in the work environment of both professionals. Both doctors and NPs work in a range of healthcare facilities, such as clinics, community health centers, hospitals, college campuses and private practices.

One of the biggest differences in how each performs in their work environment is the physical component. NPs often spend a lot of their day on their feet, providing physical care to patients in need while doctors spend a lot of time listening to patients concerns bedside.

When Should I See a Nurse Practitioner?

Seeking care from a professional with the title “doctor” is not always necessary, especially when it comes to routine exams and procedures. Nurse practitioners are just as knowledgeable and skilled in their field and can often see patients sooner than doctors.

NPs are often known for their great bedside manner. They are commonly referred to as Advanced Practice Registered Nurses (APRN) due to their extensive healthcare background and ability to care for patients at their bedsides, whether it is at home, in a hospital or another healthcare setting.

Some of the most common services that NPs offer include:

• Annual checkups, including pap smears and breast exams
• Vaccinations
• Routine screenings
• Diagnosis and treatment of minor conditions or illnesses

When it comes to pressing gynecologic problems, many women want to see a healthcare professional as soon as possible. Nurse practitioners are often able to see patients quickly to prevent delays in treatment. Visiting a NP can be comfortable and convenient for women who have concerns about their health and would like to speak with a women’s health provider.

NPss that work in women’s health are equipped to provide many common services with or without supervision from a doctor. These services may include pelvic exams, sexual health counseling, contraception counseling, mammography referrals, issues relating to menopause and age-appropriate screening tests. They may also address issues related to infertility, gynecology care after cancer and LGBT reproductive health.

Schedule An Appointment Today With A Nurse Practitioner

NPs play a key role in promoting better health and wellness for women of all ages. These essential healthcare workers screen women for sexually transmitted infections (STIs), depression, cancer and domestic abuse. They also provide care for lesbian and transgender women, as well as for menopausal women. NPs are also dedicated to educating women about a wide range of nutrition and wellness topics.

At Raleigh Gynecology & Wellness, our nurse practitioners are an important part of our healthcare team. Contact us today to schedule an appointment for routine care or to speak to us about any health concerns that you may have. Our highly trained physicians and NPs provide services to women of all ages and assist in the management of many GYN conditions and disorders.