What Causes Amenorrhea?

What Is Amenorrhea?

Amenorrhea is the term for a woman missing a monthly menstrual period. Not having a period during pregnancy or after menopause is normal. But missing periods at any other time can be a symptom of a medical issue.

There are two types of amenorrhea. Primary amenorrhea is when a woman doesn't begin her menstrual cycle by age 16.Secondary amenorrhea is when a woman misses her monthly period for three consecutive months after having normal cycles for the previous nine months. Secondary amenorrhea is more common.

What Causes Amenorrhea?

Amenorrhea has many potential causes. For primary amenorrhea, a common cause is a structural problem with the sex organs, such as underdeveloped or malfunctioning ovaries. Another common cause can be a problem with the pituitary gland, which produces a hormone necessary for menstruation. Anorexia nervosa, malnutrition, or over-exercising may also cause secondary amenorrhea. Tumors and illnesses like cystic fibrosis are other possible causes.

Pregnancy, breast-feeding, and menopause can cause secondary amenorrhea. Starting, stopping, or changing birth control can also affect menstruation.

In young women, common causes of secondary amenorrhea are over-exercising and extreme physical training. Having a poor diet, or not consuming enough calories, is another cause.

Other causes of secondary amenorrhea are:

•          Stress

•          Hormone imbalance

•          Extreme weight loss

•          Drugs or certain medications

•          Depression or ongoing illness

•          Obesity

•          Surgery of the uterus

•          Removal of the ovaries or uterus

Secondary amenorrhea can also be caused by uterine cancer, ovarian tumors, or thyroid or other gland issues.

Diagnosing Amenorrhea

Missing a period can be a sign of a serious health condition. You should see your doctor if you’ve missed three periods in a row or are 16 years of age and haven’t yet started menstruating.

Your doctor will first need to rule out pregnancy, menopause, or another normal change. He or she will ask you to describe your symptoms and medical history. You will have a pelvic exam. Urine and blood tests are also possible. Be sure to tell your doctor about your regular cycle, including when your last period was and how long they generally last. This will help your doctor make an accurate diagnosis.

Your doctor will also want to know about medication and drug use, including birth control. It is important to discuss changes to your diet or exercise routine, and any emotional challenges in your life.

Treating Amenorrhea

Treatment depends on the cause. For obesity-related amenorrhea, a weight-loss program is usually suggested. For amenorrhea caused by extreme weight loss or exercising, your doctor will recommend weight gain or less exercise. Emotional care can help with depression, stress, or issues related to extreme exercise or dieting, such as anorexia nervosa. Hormone and gland-related issues can be treated with prescription medication or other specific treatment plans. Surgery may be needed if amenorrhea is caused by structural issues or tumors.

For primary amenorrhea, certain medications, herbs, or alternative therapies can help stimulate menstruation. Your doctor will tell you about appropriate options.

Amenorrhea Prognosis

Amenorrhea is usually treatable, depending on the underlying issue. While missing a period may not seem like a health crisis, stopping menstruation carries some health risks. The main risk is loss of bone density. This can lead to fractures. Untreated amenorrhea can lead to osteoporosis later in life. Amenorrhea can also make getting pregnant difficult.

Preventing Amenorrhea

To prevent amenorrhea, attempt to maintain a normal weight, exercise regularly, learn to manage stress, and live a healthy life. Make a habit of getting regular pelvic exams, including a Pap smear. Talk to your doctor about any concerns you have about your menstrual cycle.

•          Amenorrhea refers to the absence of menstrual periods; it may be either primary (meaning a woman never developed menstrual periods) or secondary (absence of menstrual periods in a woman who was previously menstruating).

•          Genetic or inborn conditions are the most common causes of primary amenorrhea.

•          Amenorrhea may result from disorders of the ovaries, pituitary gland, or hypothalamus.

•          Intensive exercising, extreme weight loss, physical illness, and stresscan all result in amenorrhea.

•          Amenorrhea is a symptom and not a disease in itself, so amenorrhea can be prevented only to the extent that the underlying cause can be prevented.

•          Infertility and bone loss (osteoporosis) are complications of amenorrhea.

•          Treatments may include surgical correction of anatomical abnormalities, medications or hormone therapies, and treatment of any underlying conditions responsible for amenorrhea.

•          The outlook for amenorrhea varies according to the cause of the amenorrhea.

Amenorrhea is the medical term for the absence of menstrual periods, either on a permanent or temporary basis. Amenorrhea can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.

The menstrual cycle can be influenced by many internal factors such as transient changes in hormonal levels, stress, and illness, as well as external or environmental factors. Missing one menstrual period is rarely a sign of a serious problem or an underlying medical condition, but amenorrhea of longer duration may signal the presence of a disease or chronic condition.

Amenorrhea is the absence of menstruation. Menstruation is a woman's monthly period.

Primary amenorrhea is when a girl has not yet started her monthly periods, and she:

•          Has gone through other normal changes that occur during puberty

•          Is older than 15

Causes

Most girls begin menstruating between ages 9 and 18, with an average of around 12 years old. Primary amenorrhea typically occurs when a girl is older than 15, if she has gone through other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.

Being born with poorly formed genital or pelvic organs can lead to primary amenorrhea. Some of these defects include:

•          Blockages or narrowing of the cervix

•          Imperforate hymen

•          Missing uterus or vagina

•          Vaginal septum

Hormones play a big role in a woman's menstrual cycle. Hormone problems can occur when:

•          Changes occur to the parts of the brain where hormones that help manage the menstrual cycle are produced

•          The ovaries are not working correctly

Either of these problems may be due to:

•          Anorexia

•          Chronic or long-term illnesses, such as cystic fibrosis or heart disease

•          Genetic defects or disorders

•          Infections that occur in the womb or after birth

•          Other birth defects

•          Poor nutrition

•          Tumors

In many cases, the cause of primary amenorrhea is not known.

Symptoms

A female with amenorrhea will have no menstrual flow with or without other signs of puberty.

Exams and Tests

The doctor will perform a physical exam and ask questions about your medical history. A pregnancy test will be done.

Blood tests may include:

•          Estradiol

•          FSH

•          LH

•          Prolactin

•          TSH

•          T3 and T4

Other tests that may be done include:

•          17 hydroxyprogesterone

•          Chromosome analysis

•          Head CT scan

•          Head MRI scan

•          Pelvic ultrasound

•          Serum progresterone

Treatment

Treatment depends on the cause of the missing period. Primary amenorrhea caused by birth defects may require medications (hormones), surgery, or both.

If the amenorrhea is caused by a tumor in the brain (pituitary tumor):

•          Medications may shrink certain types of tumors.

•          Surgery to remove the tumor may also be needed.

•          Radiation therapy is usually only performed when other treatments have not worked.

If the condition is caused by a body-wide (systemic) disease, treatment of the disease may allow menstruation to begin.

If the amenorrhea is due to anorexia or too much exercise, periods will often begin when the weight returns to normal or the exercise level is decreased.

If the amenorrhea cannot be corrected, medicines can sometimes create a menstrual-like situation (pseudomenstruation). Medicines can help the woman feel more like her friends and family, and protect the bones from becoming too thin (osteoporosis).

Outlook (Prognosis)

The outlook depends on the cause of the amenorrhea and whether it can be corrected with treatment or lifestyle changes.

Periods are unlikely to start on their own if the amenorrhea was caused by one of the following conditions:

•          Congenital defects of the upper genital system

•          Craniopharyngioma

•          Cystic fibrosis

•          Genetic disorders

You may have emotional distress because you feel different from friends or family, or worry that you might not be able to have children.

When to Contact a Medical Professional

Call your health care provider if your daughter is older than 15 and has not yet begun menstruating, or if she is 14 and shows no other signs of puberty.

Alternative Names

Primary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary