Amenorrhea, NIH: National Institutes of Health, Available at:https://www.nichd.nih.gov/health/topics/amenorrhea
Absent Menstrual Periods
Amenorrhea is the medical term for the lack of a menstrual period. Amenorrhea is not a disease, but it can be a symptom of another condition.
Primary amenorrhea occurs when a girl has not had her first period by age 16. Secondary amenorrhea describes women who experience an absence of more than three menstrual cycles after having regular periods.
Amenorrhea is the absence of a menstrual period.
Amenorrhea is sometimes categorized as:
- Primary amenorrhea. This describes a young woman who has not had a period by age 16.
- Secondary amenorrhea. This occurs when a woman who once had regular periods experiences an absence of more than three cycles. Causes of secondary amenorrhea include pregnancy.
Having regular periods is an important sign of overall health. Missing a period, when not caused by pregnancy, breastfeeding, or menopause, is generally a sign of another health problem. If you miss your period, talk to your health care provider about possible causes, including pregnancy.
Missing a period is the main sign of amenorrhea.
Depending on the cause, a woman might have other signs or symptoms as well, such as:
- Excess facial hair
- Hair loss
- Headache
- Lack of breast development
- Milky discharge from the breasts
- Vision changes
According to the American Society for Reproductive Medicine, amenorrhea that is not caused by pregnancy, breastfeeding, or menopause occurs in a small percentage (less than 5%) of women during their lifetime.
The risk factors for amenorrhea include:
- Excessive exercise
- Obesity
- Eating disorders, such as anorexia nervosa
- A family history of amenorrhea or early menopause
- Genetics, such as having a change to the FMR1 gene, which also causes Fragile X syndrome
- Amenorrhea is often a sign of another health problem rather than a disease itself, and it can happen for many reasons. It can occur as a natural part of life, such as during pregnancy or breastfeeding. It can also be a sign of a health problem, such as polycystic ovary syndrome (PCOS).
- What causes primary amenorrhea?
Primary amenorrhea (failure of menses to occur by age 16) can result from two main causes:
- Chromosomal or genetic abnormalities can cause the ovaries to stop functioning normally. Turner syndrome, a condition caused by a partially or completely missing X chromosome, and androgen insensitivity syndrome, often characterized by high levels of testosterone, are two examples of genetic abnormalities that can delay or disrupt menstruation.
- Problems with the hypothalamus or pituitary gland in the brain can cause an imbalance of hormones that can prevent periods from starting. Conditions such as eating disorders, excessive exercise, and extreme physical or psychological stress or a combination of these factors can also disrupt the normal functioning of the hypothalamus or pituitary gland, delaying the onset of menstruation.
In rare cases, physical problems—such as missing reproductive organs or blockage of reproductive passageways—can also lead to primary amenorrhea. Missing portions of the reproductive tract can cause endocrine disruptions and may combine with hypothalamic or pituitary problems to prevent menstruation. Blockages may also prevent menstrual bleeding, making it seem like a girl has primary amenorrhea, even if her menstrual cycles are actually normal.
- What causes secondary amenorrhea?
Secondary amenorrhea (missing three menstrual periods in a row or not having periods for at least 6 months after menstruating normally) can result from various causes, such as:
- Natural causes.
- Pregnancy is the most common natural cause of secondary amenorrhea.
- Other physiologic causes include breastfeeding and menopause.
- Medications and therapies.
- Certain birth control pills, injectable contraceptives, and hormonal intrauterine devices (IUDs) can cause amenorrhea. It can take a few months after stopping one of these types of birth control for the menstrual cycle to restart and become regular.
- Some medications, including certain antidepressants and blood pressure medications, can increase the levels of a hormone that prevents ovulation and the menstrual cycle.
- Chemotherapy and radiation treatments for hematologic cancer (including blood, bone marrow, and lymph nodes) and breast or gynecologic cancer can destroy estrogen-producing cells and eggs in the ovaries, leading to amenorrhea. The resulting amenorrhea may be short-term, especially in younger women.
- Sometimes scar tissue can build up in the lining of the uterus, preventing the normal shedding of the uterine lining in the menstrual cycle. This scarring sometimes occurs after a dilation and curettage (D&C), a procedure in which tissue is removed from the uterus to diagnose or treat heavy bleeding or to clear the uterine lining after a miscarriage, a cesarean section, or treatment for uterine fibroids.
- Hypothalamic amenorrhea. This condition occurs when the hypothalamus, a gland in the brain that regulates body processes, slows or stops releasing gonadotropin-releasing hormone (GnRH), the hormone that starts the menstrual cycle. Common characteristics of women with hypothalamic amenorrhea include:
- Low body weight
- Low percentage of body fat
- Very low intake of calories or fat
- Emotional stress
- Strenuous exercise that burns more calories than are taken in through food
- Deficiency of leptin, a protein hormone that regulates appetite and metabolism
- Some medical conditions or illnesses
- Gynecological conditions, specifically those that lead to or result from hormone imbalances, may also have secondary amenorrhea as a main symptom.
- Polycystic ovary syndrome (PCOS). PCOS occurs when a woman’s body produces more androgens (a type of hormone) than normal. High levels of androgens can cause fluid-filled sacs or cysts to grow in the ovaries, interfering with the release of eggs (ovulation). Most women with PCOS either have amenorrhea or experience irregular periods, called oligomenorrhea.
- Fragile X-associated primary ovarian insufficiency (FXPOI). The term FXPOI describes a condition in which a woman’s ovaries stop functioning before normal menopause, sometimes around age 40. FXPOI results from certain changes to a gene on the X chromosome. FXPOI is fairly common among women who seek treatment for amenorrhea.
- Thyroid problems. The thyroid is a small butterfly-shaped gland at the base of the neck, just below the Adam’s apple. The thyroid produces hormones that control metabolism and play a role in puberty and menstruation. A thyroid gland that is overactive (called hyperthyroidism) or underactive (hypothyroidism) can cause menstrual irregularities, including amenorrhea.
- Pituitary tumors. The pituitary gland in the brain regulates the production of hormones that affect many body functions, including metabolism and the reproductive cycle. Tumors on the pituitary gland are usually noncancerous (benign) but can interfere with the body’s hormonal regulation of menstruation.
- Natural causes.
The treatment for amenorrhea depends on the underlying cause, as well as the health status and goals of the individual.
If primary or secondary amenorrhea is caused by lifestyle factors, your health care provider may suggest changes in the areas below:
- Weight. Having overweight or severe underweight can affect your menstrual cycle. Attaining and maintaining a healthy weight often helps balance hormone levels and restore your menstrual cycle.
- Stress. Assess the areas of stress in your life and reduce the things that are causing stress. If you can’t decrease stress on your own, ask for help from family, friends, your health care provider, or a professional listener such as a counselor.
- Level of physical activity. You may need to change or adjust your physical activity level to help restart your menstrual cycle. Talk to your health care provider and your coach or trainer about how to train in a way that maintains your health and menstrual cycles.
Be aware of changes in your menstrual cycle and check with your health care provider if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts, and any problems you experience. The first day of bleeding is considered the first day of your menstrual cycle.
For primary amenorrhea, depending on your age and the results of the ovary function test, health care providers may recommend watchful waiting. If an ovary function test shows low follicle-stimulating hormone (FSH) or luteinizing hormone (LH) levels, menstruation may just be delayed. In females with a family history of delayed menstruation, this kind of delay is common.1
Primary amenorrhea caused by chromosomal or genetic problems may require surgery. Women with a genetic condition called 46, XY gonadal dysgenesis have one X and one Y chromosome, but their ovaries do not develop normally. This condition increases the risk for cancer developing in the ovaries. The gonads (ovaries) are often removed through laparoscopic surgery to prevent or reduce the risk of cancer.2
Treatment for secondary amenorrhea, depending on the cause, may include medical or surgical treatments or a combination of the two.
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