What is amenorrhea?
Amenorrhea is the complete absence of menstruation or menstrual periods. That’s different from oligomenorrhea (less frequent periods). There are two types of amenorrhea: primary and secondary.
Primary amenorrhea typically denotes the lack of occurrence of the first menstrual period by 15 years of age. Primary amenorrhea is most often due to hormone imbalance; structural problems with organs of the reproductive system may play a role.
Women who have been menstruating regularly, who are not pregnant, and whose periods then stop for at least three months are considered to have secondary amenorrhea. Causes vary and include hormone imbalances, contraceptives, medications, stress, low body weight, excessive exercise, and disorders of the reproductive system.
Generally, the amenorrhea will resolve and menstrual periods will start again with treatment of the underlying disease, disorder or condition.
Seek prompt medical care if you have missed two or more consecutive periods. If you have reached the age of 15 years and have not yet started menstruating, seek prompt medical care.
What are the different types of amenorrhea?
Amenorrhea is the complete absence of menstrual periods. There are two types of amenorrhea: primary and secondary.
- Primary amenorrhea is the lack of the first menstrual period by 15 years of age. There are several possible reasons for primary amenorrhea, including disorders of the ovaries, genetic defects, or an infection contracted while still in the womb or shortly after birth. Primary amenorrhea may also be the result of childhood cancer.
- Secondary amenorrhea means you have regular periods but your period has stopped for at least three missed periods in a row, not due to pregnancy. Secondary amenorrhea often occurs in women who are using hormone-releasing contraceptives. Secondary amenorrhea may also be caused by hormone imbalances, excessive exercise, eating disorders, obesity, anxiety or other emotional strain. Women with body fat of less than 15% often experience amenorrhea.
What other symptoms might occur with amenorrhea?
Amenorrhea may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the endocrine system may also involve other body systems.
Common symptoms that may occur along with amenorrhea
Amenorrhea may accompany other common symptoms including:
- Abdominal pain or cramping
- Abdominal, pelvic, or lower back pain that can be severe
- Bleeding or spotting between periods
- Irritability and mood changes
Other symptoms that may occur along with amenorrhea
Amenorrhea may accompany symptoms related to other body systems including:
- Breast discharge
- Excess hair growth on the body
- General ill feeling
- Irritability and mood changes
- Unexplained weight gain or loss
Symptoms that might indicate a serious condition
In some cases, amenorrhea may occur with other symptoms that might indicate a serious condition and should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have amenorrhea along with other serious symptoms, including severe abdominal, pelvic, or lower back pain.
What causes amenorrhea?
There are several possible reasons for primary amenorrhea, including disorders of the ovaries, genetic defects, or an infection contracted while still in the womb or shortly after birth.
The leading cause of secondary amenorrhea is pregnancy. Common causes for secondary amenorrhea are hormone-releasing contraceptive devices, anxiety, rigorous excessive exercise, eating disorders, obesity, or low body fat.
Hormonal causes of amenorrhea
Amenorrhea may be caused by hormonal imbalances including:
- Changes in estrogen or progesterone levels
- Complications from hormone-releasing contraceptives (birth control pill, patch or injection; intrauterine devices)
- Genetic or inherited conditions
- Hyperthyroidism (overactive thyroid)
- Hypothyroidism (underactive thyroid)
- Premature ovarian failure
- Turner syndrome (female genetic disorder involving a missing or incomplete sex chromosome)
Other causes of amenorrhea
Amenorrhea can be caused by conditions that damage the ovaries, the uterus, or the organs that regulate hormone production by the ovaries. Examples include:
- Asherman’s syndrome (the formation of scar tissue in the uterus after medical procedures or infections)
- Side effects of some medications, such as chemotherapy drugs for cancer
Psychological causes of amenorrhea
Amenorrhea can be caused by psychological disturbances including:
- Anorexia nervosa
Physical causes of amenorrhea
Amenorrhea can be caused by physical changes in your body including:
- Excessive exercise
- Low body fat (less than 15%)
- Low body weight
- Rapid weight loss from a restrictive diet
Serious or life-threatening causes of amenorrhea
In some cases, amenorrhea may be a symptom of a serious or life-threatening condition that should be immediately evaluated by a medical professional. These include:
- Cancer of the pelvic organs, brain, or adrenal glands
- Pituitary tumor
What are the risk factors for amenorrhea?
A number of factors increase the risk of developing amenorrhea. Not all people with risk factors will develop amenorrhea. Risk factors for amenorrhea include:
- Rigorous athletic training which can result in lower than normal body fat
- Family history of amenorrhea, early menopause, thyroid disease, or genetic defects
- History of certain gynecologic procedures, including dilation and curettage (D&C) and loop electrodiathermy excision procedure (LEEP)
Reducing your risk of amenorrhea
You may be able to lower your risk of amenorrhea by:
- Maintaining a healthy body weight and body fat
- Getting regular physical exercise
- Having regular doctor visits, especially if you have a family or personal medical history that puts you at risk for amenorrhea
How is the cause of amenorrhea diagnosed?
Diagnosis of amenorrhea begins with a complete physical exam and pelvic exam. Your provider will ask about your medical history, menstrual history, medicines and supplements you take, your exercise and eating habits, and family medical history. Your healthcare provider will want to rule out other medical conditions or medicines that may be causing or contributing to amenorrhea.
Questions for diagnosing the cause of amenorrhea
To diagnose your condition, your doctor or licensed healthcare provider will ask you several questions related to your amenorrhea including:
- Have you ever had a menstrual period?
- Are you, or could you be pregnant?
- What are you using for birth control?
- Are you in menopause? When was your last period?
- What changes, if any, have you noticed in your menstrual periods?
- Have you missed any menstrual periods?
- Do you have spotting or bleeding between menstrual periods?
Tests or exams to diagnose the cause of amenorrhea
Your doctor or healthcare provider may order the following tests to help diagnose the cause of amenorrhea:
- Pregnancy test to rule out amenorrhea due to pregnancy
- Blood tests to measure hormone levels, thyroid function, or ovary function
- Genetic tests to diagnose Turner syndrome or other genetic causes of amenorrhea
- Head CT scan or MRI scan to check for a pituitary tumor
- Pelvic ultrasound, a noninvasive imaging test to examine female pelvic organs
- Hysteroscopy to examine the inside of your uterus and possibly biopsy of the lining of the uterus
How is amenorrhea treated?
Treatment of amenorrhea depends on the underlying cause. Treating the disorder may allow menstruation to begin or return.
- Amenorrhea due to low body weight, low body fat, anorexia, bulimia, or excessive exercise, can be treated by changing eating and exercise habits to reach normal body weight.
- Amenorrhea due to birth defects may be treated with hormone medicine, surgery or both.
- Amenorrhea caused by a brain tumor may be treated with medicines to shrink the tumor or surgery to remove the tumor.
What are the potential complications of amenorrhea?
Because amenorrhea can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your healthcare professional design specifically for you to reduce the risk of potential complications including:
- Cancer of the uterus
- Inability to participate normally in activities
- Withdrawal or depression