In this article:
What Is Amenorrhoea?
Amenorrhoea refers to the absence of menstrual periods for a prolonged period of time, usually three or more months.Types of amenorrhoea:
- Primary amenorrhoea: This is when a person does not have their periods by the age of 15.
- Secondary amenorrhoea: This occurs when a person suddenly stops having periods for three or more months, despite having regular periods before. Irregular periods for six or more months can also be considered as secondary amenorrhoea.
- Hormonal imbalances like high prolactin or thyroid problems
- Polycystic ovary syndrome (PCOS), a condition in which periods are often irregular or absent
- Excessive exercise or low body weight. This is especially common in athletes or people with an eating disorder.
- Stress can disrupt hormone regulation
- Medical conditions like thyroid, premature ovarian insufficiency, uterine infections like tuberculosis or chronic illnesses
- Post-D&C adhesions (Asherman’s Syndrome) can cause scarring inside the uterus and develop after a vigorous dilation and curettage (D&C) or an incomplete abortion leading to cramping without bleeding. This often requires surgical treatment to remove the adhesions.
- Medications like birth control, chemotherapy and antipsychotics
- Low haemoglobin and severe anaemia can also impact the menstrual cycle.
Ovulation and Its Role in Pregnancy
Ovulation refers to the release of an egg from either one of the ovaries. Pregnancy can only take place if ovulation occurs. Usually, a menstrual cycle occurs about fifteen days after ovulation, but this is not always the case. Ovulation without a period:
If you have irregular periods, it is entirely possible that you may have ovulated but not had a period. Sometimes, you may release an egg, but not bleed due to hormonal imbalances or uterine abnormalities.
In such cases, it is extremely important to track ovulation. You can do this by tracking the symptoms of ovulation, like the texture of your cervical mucus and basal body temperature. You can also rely on ovulation predictor kits to help you identify if you have ovulated in the absence of periods.
Is It Possible To Get Pregnant With Primary Amenorrhoea?
Primary amenorrhoea is usually a sign that ovulation has not started. This makes natural conception unlikely. However, this too, is largely dependent on the underlying cause of the amenorrhoea.Factors Influencing Fertility In Primary Amenorrhoea
- Delayed puberty, and if periods have not occurred till the age of 15, can resolve on its own.
- Genetic conditions like Turner’s syndrome are often associated with infertility.
- Congenital abnormalities like Müllerian agenesis may cause periods to be absent but can allow egg retrieval for IVF in some cases.
- Hormonal disorders can be resolved using treatment, restoring ovulation and fertility.
Fertility Treatments With Primary Amenorrhoea
- Hormone therapy might help with restoring ovulation in some cases
- In some cases where ovulation is not possible, egg donation and IVF might be considered
Is It Possible To Get Pregnant With Secondary Amenorrhoea?
Secondary amenorrhoea is more common than primary amenorrhoea. It can arise from temporary issues such as stress, illness or long-term conditions like PCOS or thyroid disorders. Secondary amenorrhoea situations where pregnancy may occur:
- Stress-induced amenorrhoea: In cases of high stress, ovulation may occur unpredictably. This makes the cycle unpredictable, but pregnancy may still occur.
- Postpartum amenorrhoea: Ovulation may return before the first postpartum menstrual cycle, meaning it is possible to get pregnant without a period.
- Perimenopause: During perimenopause, ovulation may still occur sporadically. Pregnancy is possible till menopause is confirmed.
Diagnosis and Treatment of Amenorrhoea to Restore Fertility
Your doctor will conduct a few tests to check if you have amenorrhoea and how to treat it.Medical evaluation:
- Hormone tests like prolactin, thyroid, AMH(Anti-Müllerian Hormone), LH (luteinising hormone) and FSH (follicle-stimulating hormone)
- Pelvic ultrasound to check for ovarian cysts or structural abnormalities
- Medical history and physical exam to understand lifestyle factors, weight and medical history
- You can consult your doctor to ask them about ovulation-stimulating medications
- Hormonal therapies like birth control and hormone replacement therapies may be prescribed to induce periods
- Your doctor might also recommend lifestyle changes like losing or gaining weight, reducing excessive exercise and stress management
Special Cases of Amenorrhoea
- Amenorrhoea caused by PCOS: PCOS is a very common cause of absent or irregular periods. However, fertility can often be restored with medications. Consult your doctor to find out which medications you should take.
- Amenorrhoea after using birth control: Some people might experience a delay in the return of their periods after they stop using birth control pills. While most people resume normal ovulation cycles after 3-6 months, some people might require medical assistance.
- Amenorrhoea caused by eating disorders or excessive exercise: If you skip periods due to excessive exercise or eating disorders, you might be advised to reduce the intensity of your workouts. Long-term amenorrhoea may require hormone replacement therapies.
- Amenorrhoea from premature ovarian insufficiency: This occurs when the ovarian reserve gets depleted early in life, such as before the age of 40. If occasional ovulation occurs, pregnancy may still be possible. Egg donation is a common solution in these cases.
Signs To Seek Medical Help
- If you have not had periods till the age of 15
- If your periods have stopped for three or more months and the cause is unknown
- If you have been trying to conceive for 6-12 months without success
Why Early Intervention Is Important
An early diagnosis can help you understand the reasons for your amenorrhoea and help improve your fertility outcomes. Working with a fertility specialist can help with treatment and family planning.Additionally, working with a fertility specialist can help you get a personalised approach to your condition based on your age, weight and lifestyle.
Amenorrhoea does not necessarily mean you cannot get pregnant, but it does signal that ovulation might be disrupted, which reduces the chances of conceiving. For some people with amenorrhoea, ovulation can still happen sporadically, which means pregnancy can also occur unexpectedly. However, some people need medical intervention for the same. Many people with amenorrhoea can achieve their goal of getting pregnant, with proper care, evaluation and treatment.
FAQs on Can You Get Pregnant If You Have Amenorrhoea
- Can I get pregnant if I miss my period for four months?
Missing periods for four months does not necessarily mean that ovulation has not occurred, however, it would be best to check with your doctor to find out the cause of the missing periods and then try to get pregnant. - Can I miss my periods if I exercise?
Moderate exercise done regularly is actually good for your reproductive health. However, it is important to remember that excessive exercise can cause more harm than good. Too much exercise can disrupt your hormonal balance and stop your periods.
