Amenorrhea? Women Health the Period Cycle

What causes amenorrhea?

There are many possible causes of amenorrhea, including the following:

• Pregnancy – If a female is sexually active and she doesn’t use contraception, or if her method of contraception has failed, amenorrhea can mean that she is pregnant.
• Changes in weight – Girls who lose or gain a lot of weight may have no periods or skip periods because she does not have the right balance of foods to keep her body healthy. 
• Disordered eating – Many girls will develop amenorrhea if they are too thin (low BMI), have anorexia nervosa, bulimia, or other disordered eating such as using vomiting or excessive dieting to control weight.
• Exercise – Girls who participate in sports such as running or gymnastics or in activities such as ballet often have athletic amenorrhea. This can be due to low weight, weight loss, or stress. Even an athlete whose weight is normal may not be taking in enough nutrition to keep her body healthy and may skip periods.
• Polycystic Ovary Syndrome (PCOS) – Girls with PCOS typically have irregular menstrual cycles and excess hair growth or acne. They are often overweight. Girls with PCOS may have no periods (amenorrhea) or irregular periods, such as fewer than 9 periods a year or 3 or more months going by without a period.
• Obesity – Being more overweight makes a girl more likely to have irregular menstrual periods.
• Endocrine problems – Low or high thyroid hormone, too little or too much adrenal hormones such as cortisol, and too much prolactin, a hormone secreted by the pituitary gland in the brain, can cause irregular periods or amenorrhea. High prolactin levels can also be caused by medications such as risperidone.
• Chronic illness – Girls with many diseases such as Crohn’s disease, celiac disease, cystic fibrosis, sickle disease, lupus, diabetes, and others may have irregular menstrual periods or amenorrhea because of low weight, stress, or a flare in their illness.
• Medications and herbs – Some medications can cause amenorrhea. Be sure to tell your health care provider about ALL the medications and/or over-the-counter supplements and herbs that you take.
• Ovary problems – Sometimes the ovaries do not make enough estrogen to cause periods because of a genetic problem such as Turner syndrome, previous radiation or chemotherapy to treat a tumor, lack of enough follicles in the ovary for the teen and adult years, and many other reasons. The condition is called primary ovarian insufficiency and is treated with hormones to replace the estrogen that the ovaries normally make.
• Congenital anomalies of the reproductive tract – A birth defect such as an underdeveloped or absent uterus (the organ where menstrual blood comes from) can cause lack of periods. Although rare, if a teen girl is 15 or older or started her breast development 3 years ago and doesn’t have her period yet, a congenital anomaly may be considered and an ultrasound may be ordered by her health care provider to see if the uterus has developed.
• Birth control (intrauterine devices, implantable rod, depot shot, continuous pill) – Some birth control methods make you more likely to have no periods or skip periods. This is a normal side effect of these medications (and is why some women prefer these types of birth control). You should talk to your doctor if you are concerned about pregnancy or amenorrhea on birth control.

How is amenorrhea diagnosed?

Not having a period for more than a couple of months may not be normal, and finding out why is important. Amenorrhea may be completely normal if you are on birth control, but you should check with your health care provider if this is an expected side effect of you chosen form of birth control. Diagnosis starts with having a pregnancy test and a medical evaluation by a health care provider (HCP).

The exam begins with reviewing your medical history.

For example, your HCP will likely ask the following questions:

• When did you start to go through puberty and develop breasts?
• Have you ever had any vaginal bleeding?
• When was your last menstrual period?
• Has your weight changed?
• Are you under stress or depressed?
• Do you have any foods you do not eat? Have you tried to lose weight through restricting what you eat, vomiting, or using laxatives?
• How much do you exercise?
• Do you feel like you have more hair on your face or abdomen than other women in your family?
• Have you ever had sexual contact or sexual intercourse?
• Do you use contraception?
• Do you take any medicine? If so, what?

The other part of the evaluation is a physical exam. Your HCP will listen to your heart and lungs, check your thyroid gland (in your neck), and check your body for any skin changes or excess hair. It’s important to tell your HCP if you remove any unwanted hair, particularly on your face (upper lip/sideburns/chin) or on your chest or back.

Your HCP will tell you if a pelvic exam is important to make sure that everything is okay with your hymen, labia, vagina, cervix and uterus. Instead of a complete pelvic exam, your HCP may do certain parts of the pelvic exam such as checking to make sure your hymen is open and using a small Q-tip in your vagina to make sure the length is normal. Your HCP may also have you get an ultrasound.

Your HCP may then obtain blood tests to look at hormone levels or refer you to a specialist in adolescent medicine or gynecology who sees girls with irregular periods.

Does it matter if you skip periods?

Many girls will skip an occasional period if they have just started their periods, or are stressed or ill, but regular periods are sign that you are healthy and making enough estrogen to keep your bones strong. So if you’re skipping periods, it’s important to find out why and whether you need treatment. Make sure that you take in 1300 mg of calcium and 600 units vitamin D per day, which is the equivalent of about 3-4 glasses of milk or 5-6 cups of cooked greens. Other dietary sources of calcium include fortified tofu, fortified orange juice, and yogurt.

What is the treatment for amenorrhea?

Treatment depends upon the cause of the amenorrhea and may include:

• Changing your exercise pattern
• Talking with a nutritionist and eating a healthy diet
• Seeing a counselor about stress or disordered eating
• Hormones such as progesterone, estrogen, or birth control pills

What’s important is that you listen to the options and decide what type of treatment is best for you.

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What is absent menstruation?

Highlights

1. Absent menstruation, also known as amenorrhea, is the absence of menstrual periods. There are two types of absent menstruation. The type depends on whether menstruation hasn’t occurred by a certain age, or whether menstruation has occurred and is then absent.
2. Absent menstruation may occur for a variety of reasons. The most common of these include natural causes, lifestyle factors, and hormonal imbalances.
3. It’s important to see a doctor about absent menstruation, as the underlying cause may require treatment. Absent menstruation often resolves once the cause is treated.

Absent menstruation, or amenorrhea, is the absence of menstrual bleeding. It happens when a girl hasn’t had her first menstrual period by age 16. It also occurs then a woman fails to menstruate for 3 to 6 months.

Amenorrhea can happen for many reasons. The most common cause is pregnancy. However, amenorrhea may also be caused by various lifestyle factors, including body weight and exercise levels. In some cases, hormonal imbalances or problems with the reproductive organs might be the cause.

You should see your doctor if you’re experiencing amenorrhea. The underlying cause of your missed periods may require treatment.

Types of absent menstruation

The two types of amenorrhea are referred to as primary and secondary.

Primary amenorrhea is when a teenage girl has reached or passed the age of 16 and still hasn’t had her first period. Most girls begin menstruating between ages 9 and 18, but 12 is the average age.

Secondary amenorrhea is when a woman has stopped menstruating for at least three months. This is the more common form of amenorrhea.

In most cases, both types can be treated effectively.

Causes of absent menstruation

Primary and secondary amenorrhea can occur for numerous reasons. Some causes are natural, while others are medical conditions that need to be treated.

• Natural causes most likely to cause amenorrhea include pregnancy, breast-feeding, and menopause.
• Lifestyle factors may include excessive exercise and stress. Also, having too little body fat or too much body fat may also delay or stop menstruation.
• Hormonal imbalances may cause amenorrhea. They are usually triggered by tumors on the pituitary gland or the thyroid gland. Low estrogen levels or high testosterone levels can also cause them.
• Medications can cause amenorrhea in some women. Antipsychotics and antidepressants are often involved. Chemotherapy drugs and medications that treat high blood pressure can cause problems with menstruation as well. Suddenly stopping birth control pills may also lead to several months of absent periods before the cycle returns to normal.
• Physical defects such as structural problems in the female reproductive organs might be responsible for absent or delayed menstruation. These issues can result from birth defects, tumors, or infections that occurred in the womb or shortly after birth. In rare cases, missed periods could be a symptom of Asherman’s syndrome. This occurs due to scarring in the uterus after surgery, which can prevent mestruation.
• Genetic disorders or chromosomal disorders, such as Turner syndrome and Sawyer syndrome, can sometimes cause late menstruation.

When to see a doctor about absent menstruation

A teenage girl who hasn’t started her periods by at least age 16 should see a doctor. A trip to the doctor’s office is also necessary if she is age 14 or older and hasn’t experienced any signs of puberty yet. These changes would include the following in numbered order of appearance:

1. thelarche (breast bud development)
2. pubarche (pubic hair development)
3. menarche (onset of menstrual periods)

Menstruating women and teens should see their doctor if they have missed three or more periods in a row.

What to expect at a doctor’s appointment

When you see your doctor about amenorrhea, your doctor will perform a physical exam and ask you a series of questions. Be prepared to talk about your normal menstrual cycle, your lifestyle, and any other symptoms you’re experiencing. Your doctor will also order a pregnancy test if you haven’t had a period in three months. If that condition is ruled out, you may need more tests to determine the underlying cause of your missed periods. These diagnostic tests may include:

• Blood tests, which will allow your doctor to check hormone levels in your body. Prolactin, luteinizing hormone, and follicle stimulating hormone are all related to menstruation. Determining these levels can help your doctor determine or rule out the cause of your absent periods.
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• Ultrasound is an imaging test that uses high frequency sound waves to create detailed pictures of the inside of your body. It enables your doctor to view various organs, such as the ovaries and uterus, and check for abnormal growths.
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• CT scan is another type of imaging test that uses computers and rotating X-ray machines to create cross-sectional images of the body. These images allow your doctor to look for masses and tumors in your glands and organs.

Treatment for absent menstruation

Treatment for amenorrhea varies depending on the underlying cause. Hormonal imbalances can be treated with supplemental or synthetic hormones, which can help normalize hormone levels. Your doctor may also want to remove ovarian cysts, scar tissue, or uterine lesions that are causing you to miss your menstrual periods.

Your doctor may also recommend making simple lifestyle changes if your weight or exercise routine is contributing to your condition. Ask your doctor to refer you to a nutritionist or dietitian, if necessary. These specialists can teach you how to manage your weight and physical activity in a healthy way.

What you can do now

Schedule an appointment with your doctor so they can determine the cause of your amenorrhea. Make sure you stick with your treatment plan and attend all follow-up appointments. Always contact your doctor if your condition doesn’t improve with medical treatments or lifestyle modifications.