LIVE QUESTIONS AND ANSWERS

Question : Doctor Richard, I have not seen my menses for past 3 months, what is the cause? Any treatment for me?

Answer : There are several causes of absence of menses in a woman. However, the first striking thing in the mind of a doctor for a woman who failed to see her period is that the woman is pregnant until proven otherwise. In other words pregnancy is the commonest cause of absence of menses in women.
Apart from pregnancy, there are other problems in a woman that can make her not see menses.
1. Age : Usually between the 13 and 20 years of age, menstrual flow may not be regular. Most of the girls that suffer it later have their periods normal.

2. Menopause : Between the ages of 45 and 55 years, a woman's period may stop finally. if period after the age 45 stops for 6months, menopause is confirmed.
3. Abortion or Miscarriage : After D&C there could be gumming together of the two surfaces of the womb making menses difficult to come out or the flow might reduce.
4. PCOS : Polycystic Ovarian Syndrom. This a hormonal problem. It usually manifests with menstural delay, spotting, no ovulation and difficulty in acheiving pregnancy.            
5. High Prolactin level. (Hyperprolactinaemia). This is also a hormonal problem. In this case, one of the hormones that make a breastfeeding mother to produce breast milk called prolactin is high in the blood. Most times it manifests with breast milk or water- like secretion from the breast in a non pregnant or non breast feeding lady. That could also cause delay in menses and child bearing.
6. Congenital abnormality : No menses due to complete coverage of the hymen of the vagina. This manifest with monthly waist pain during the assumed menstrual period but no flow.

TREATMENT

1. For a woman who has entered menopause but still desire to have children, ICSI fertility treatment can help her. Through assisted reproductive technology, A 60 year old had become pregnant and delivered twin through this technology.
2. The case of post abortion absence or reduced menses can be treated depending on the degree of damage of the inner lining of the womb during the abortion. New technology called hysteroscopy can be used for diagnosis and treatment of it.
3. PCOS is a challenging hormonal problem. It can be treated with a combination of some drugs and a laparoscopic procedure called Ovarian Drilling. See your doctor.
4. Hyperprolactinaemia : Secreting breast milk when you are neither pregnant nor breast feeding. This can be treated with drugs like Parlodel, Bromocriptine, Dostinex. First go for hormone profile test to confirm before you treat.
5.For Congenital abnormality Treatment requires surgical opening of Hymen.

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