The first menstruation occurs around the age of 12. Normally, the menstrual cycle lasts from 21 to 35 days, with the average menstrual bleeding starting after the 28th day. Every woman’s menstrual cycle is different – for some it comes exactly on the same day, and for others there may be a difference of several days, which is normal. What is amenorrhea and how many types are there? Amenorrhea is the absence of menstruation. It is of 2 types – primary and secondary. Primary amenorrhea occurs in girls who have not yet menstruated by the age of 15. Reasons can be some anatomical features or hormonal imbalance. Secondary amenorrhea is when menstruation does not occur for 2 consecutive months. The most common cause of secondary amenorrhea is pregnancy. Other natural causes are breastfeeding, taking birth control pills, menopause, certain medications, chemotherapy, etc. What are the symptoms? The most common accompanying symptoms of amenorrhea are headache, hair loss, presence of acne, pelvic pain, nausea, facial hair, impaired vision, nipple discharge, etc. How does lifestyle affect menstruation? Some factors contribute to the occurrence of amenorrhea. These are: Too low weight – it disrupts hormonal functions and suppresses ovulation; The cycle stops often in women who suffer from an eating disorder (anorexia and bulimia); In women practicing ballet, gymnastics or other sports requiring discipline and training, an interruption of the menstrual cycle may occur; Other risk factors can be – family burden, some past gynecological operations, procedures related to excisions, etc. How is a diagnosis made? Diagnosis can be difficult if pregnancy or menopause is not present. It is recommended that every woman keep a diary in which she records how long each period lasts, how long menstrual bleeding lasts, whether there are changes in nutrition – whether a diet has been started, whether strength exercises are done, whether there have been violent emotions, provoking anger or stress, etc. After the history, the obstetrician-gynecologist examines the organs in the small pelvis to check if there is any problem with them. The attending physician may order some tests to determine the cause, such as: Pregnancy test; Blood tests for thyroid and adrenal hormone testing; In the presence of primary ovarian failure, genetic tests can be done; What can be the treatment? Treatment depends on the cause of the lack of menstrual bleeding. Sometimes the cause is not serious and requires treatment with some drugs or hormonal preparations. The attending physician can most accurately determine what treatment will help. References: https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299 https://my.clevelandclinic.org/health/diseases/3924-amenorrhea https://familydoctor.org/condition/amenorrhea/amp/