Is it normal to not have menstruation at the age of 46?

Absence of menstruation at the age of 46 may be a normal symptom of perimenopause, or it may be abnormal amenorrhea. Women usually enter perimenopause at the age of 45-55, when ovarian function gradually declines and menstruation stops. If it is accompanied by hot flashes, insomnia and other symptoms, it is usually physiological amenorrhea. ； If it does not reach this age or is accompanied by abnormal bleeding, abdominal pain, etc., you need to be alert to pathological factors.

Perimenopause is the natural decline of female reproductive function. The levels of estrogen and progesterone secreted by the ovaries decrease, the cyclic changes of the endometrium weaken, and the menstrual cycle gradually lengthens until it stops. During this stage, menstrual volume may decrease and menstrual cycles may become irregular. Eventually, menopause will be diagnosed if no menstrual cramps occur for more than 1 year. Most women are accompanied by vasomotor symptoms such as hot flashes, night sweats, mood swings or sleep disorders during this process, and these symptoms usually last for 1-3 years and gradually resolve.

Abnormal amenorrhea requires consideration of hypothalamic-pituitary-ovarian axis dysfunction, such as long-term anovulation caused by polycystic ovary syndrome, which manifests as amenorrhea accompanied by hirsutism and acne.； Uterine adhesions may cause menstrual blood to be unable to be discharged, and are common in those who have had a history of uterine cavity operations. ； Premature ovarian insufficiency can cause menopausal symptoms before the age of 40. Endocrine diseases such as thyroid dysfunction and hyperprolactinemia can also interfere with menstruation. Malignant tumors such as endometrial cancer may have amenorrhea as the first symptom, especially when accompanied by irregular vaginal bleeding, which requires urgent investigation.

It is recommended to record menstrual changes and accompanying symptoms, and conduct regular gynecological examinations, six hormone tests, and pelvic ultrasound examinations. Maintain a balanced diet and increase the intake of phytoestrogens such as soy products and dark green vegetables. ； Moderate exercise can help relieve menopausal symptoms ； If necessary, hormone replacement therapy can be used under the guidance of a doctor. If sudden amenorrhea is accompanied by headache, vision changes, or lactation, seek medical attention immediately to rule out pituitary disease.