Amenorrhea refers to the absence of menstrual periods; It can be either primary/primary (meaning that a woman does not have a period at all) or secondary/secondary (the absence of menstrual periods in a previously menstruating woman). You can find more information below.
What is amenorrhea?
Amenorrhea is the absence of a menstrual period in women – one or more missed periods. Amenorrhea is seen in women who missed at least three periods in a row, as in girls who did not start menstruating until the age of 15. The most common cause of amenorrhea is pregnancy. Other causes of this condition include problems with the reproductive organs or glands that help regulate hormone levels. Treating the underlying condition usually resolves the amenorrhea.
Primary amenorrhea is typically the result of a genetic or anatomical condition in teenage girls who never develop a menstrual period (up to 16 years of age) and are not pregnant. Many genetic conditions characterized by amenorrhea are conditions where some or all of the normal female organs do not form or function normally during fetal development.
Pregnancy is an obvious cause of amenorrhea and is the most common cause of secondary amenorrhea. Other causes are varied and may include conditions affecting the ovaries, uterus, hypothalamus, or pituitary gland.
What causes amenorrhea?
Amenorrhea can occur for a variety of reasons. Some are normal throughout a woman’s life, while others may be a side effect of medications or a sign of a medical problem.
During the normal course of your life, you may not have a period due to natural causes such as:
birth control pills
Some women who use birth control pills may not menstruate. Even after stopping oral contraceptives, it may take some time for regular ovulation and menstruation to return. Injectable or implanted contraceptives can cause amenorrhea, as can some intrauterine devices.
Some of the following medications can cause menstrual periods to stop:
- cancer chemotherapy
- blood pressure medications
- allergy medications
Sometimes lifestyle factors contribute to the absence of a menstrual period, such as:
- Low body weight: Extremely low body weight interrupts many hormonal functions in your body, potentially stopping ovulation. Women with eating disorders such as anorexia or bulimia often stop menstruating because of these abnormal hormonal changes.
- Excessive exercise: Women who participate in rigorous activities such as ballet may have their menstrual cycles interrupted. Several factors combine to contribute to menstrual loss in athletes, including low body fat, stress, and high energy expenditure.
- Stress: Mental stress can temporarily alter the functioning of your hypothalamus, an area of your brain that controls the hormones that regulate your menstrual cycle. As a result, ovulation and menstrual bleeding may stop. Regular menstrual periods usually resume after your stress has subsided.
Many types of medical problems can cause hormonal imbalance, including:
- Polycystic ovary syndrome (PCOS): PCOS causes relatively high and sustained hormone levels rather than the fluctuating levels seen in the normal menstrual cycle.
- Thyroid malfunction: Thyroid diseases such as an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism) can cause menstrual irregularities, including amenorrhea.
- Pituitary tumor: A noncancerous (benign) tumor in your pituitary gland can interfere with the hormonal regulation of menstruation.
- Early menopause: Menopause usually begins around age 50. But for some women, the egg supply of the ovaries decreases before age 40 and menstrual bleeding stops.
Problems with the genitals can also cause the absence of a menstrual period. Examples include:
- Uterine scar: Asherman’s syndrome is a condition in which scar tissue forms on the lining of the uterus. It can sometimes occur after a dilation and curettage, cesarean section, or treatment for uterine fibroids. Uterine scarring interferes with the normal formation and shedding of the uterine lining.
- Lack of reproductive organs: Sometimes problems arise during fetal development that cause a girl to be born without a large part of the reproductive system such as the uterus, cervix or vagina. Since the reproductive system does not develop normally, there cannot be a menstrual cycle.
- Structural abnormality of the vagina: Obstruction of the vagina can prevent visible menstrual bleeding. The vagina may have a membrane or wall that blocks the outflow of blood from the uterus and cervix.
What are the symptoms of amenorrhea?
The main symptom of amenorrhea is the absence of menstrual periods. Depending on the cause of amenorrhea, you may experience other symptoms, such as:
- nipple discharge
- hair loss
- vision changes
- Excess facial hair
- pelvic pain
- acne (pimples)
When should you see a doctor?
You should consult your doctor if you have missed at least three periods in a row or if you have never had a period and you are 15 years of age or older.
How is amenorrhea diagnosed?
During the interview, your doctor will do a pelvic exam to check for any problems with your reproductive organs. If you have never had a period, your doctor may examine your breasts and genitals to see if you are experiencing the normal changes of puberty.
Amenorrhea can be a symptom of a number of complex hormonal issues. Finding the underlying cause can take time and require multiple types of testing.
Various blood tests may be necessary, including:
- Pregnancy test: This will likely be the first test your doctor recommends to rule out or confirm a possible pregnancy.
- Thyroid function test: Measuring the amount of thyroid stimulating hormone (TSH) in your blood can determine if your thyroid is working properly.
- Ovarian function test: Measuring the amount of follicle stimulating hormone (FSH) in your blood can determine if your ovaries are working properly.
- Prolactin test: Low levels of the hormone prolactin can be a sign of a pituitary gland tumor.
- Male hormone test: If you are experiencing increased facial hair and decreased voice, your doctor may want to check the level of male hormones in your blood.
Hormone loading test
For this test, you take a hormonal drug for seven to 10 days to induce menstrual bleeding. The results of this test can tell your doctor if your periods have stopped due to a lack of estrogen.
Depending on your amenorrhea symptoms and the results of your blood tests, your doctor may recommend one or more imaging tests, including:
- Ultrasound: This test uses sound waves to produce images of internal organs. If you have never had a period, your doctor may recommend an ultrasound test to check for any abnormalities in your reproductive organs.
- Computed tomography (CT): CT scans combine many X-ray images taken from different directions to create cross-sectional views of internal structures. A CT scan can show whether your uterus, ovaries, and kidneys appear normal.
- Magnetic resonance imaging (Emar-MRI): MRI uses radio waves with a strong magnetic field to produce extraordinarily detailed images of soft tissues in the body. Your doctor may order an MRI to check for a pituitary tumor.
If other tests don’t reveal a specific cause, your doctor may recommend hysteroscopy, a test in which a thin, lighted camera is passed through your vagina and cervix to look inside your uterus.
How is amenorrhea treated?
Treatment depends on the underlying cause of your amenorrhea. In some cases, birth control pills or other hormone treatments can restart your menstrual cycles. Amenorrhea caused by thyroid or pituitary disorders can be treated with medications. If a tumor or structural blockage is causing the problem, surgery may be necessary.
Lifestyle and home remedies
Some lifestyle factors — such as exercising too much or eating too little — can cause amenorrhea. Therefore, you should strive for balance in work, leisure and rest. You can evaluate areas of stress and conflict in your life. If you are unable to reduce stress on your own, you can seek help from family, friends or your doctor.
You should be aware of changes in your menstrual cycle and consult your doctor if you have any concerns. You can keep track of when your menstrual periods occur. It’s helpful to note the date your period started, how long it lasted, and any uncomfortable symptoms you’re experiencing.