What Is Amenorrhea?
Amenorrhea is when you aren’t getting your periods even though you’ve been through puberty, aren’t pregnant, and haven’t gone through menopause.
It’s not about having irregular periods. If you have amenorrhea, you never get your period. Although it’s not a disease, you should tell your doctor about it because it might be a symptom of a medical condition that can be treated.
Amenorrhea Types
There are two types of amenorrhea:
Primary amenorrhea. This is when young women have not had their first period by the age of 15.
Secondary amenorrhea. This is when you have had normal menstrual cycles, but they stop for 3 or more months.
Amenorrhea Symptoms
Besides not having your period, there are some other symptoms you may have, depending on the cause of your amenorrhea:
Causes of Amenorrhea
Many things could cause amenorrhea.
Possible causes of primary amenorrhea (when you never get your first period) include:
- Failure of the ovaries
- Problems in the central nervous system (brain and spinal cord) or the pituitary gland (a gland in the brain that makes the hormones involved in menstruation)
- Problems with reproductive organs
In many cases, doctors don’t know why a first period never happens.
Common causes of secondary amenorrhea (when someone who has had normal periods stops getting them) include:
- Pregnancy
- Breastfeeding
- Stopping the use of birth control
- Menopause
- Some birth control methods, such as Depo-Provera or certain types of intrauterine devices (IUDs)
Other causes of secondary amenorrhea include:
- Stress
- Poor nutrition
- Depression
- Certain prescription drugs, including antidepressants, antipsychotics, blood pressure medicines, and allergy medications
- Extreme weight loss
- Over-exercising
- Ongoing illness
- Sudden weight gain or being very overweight (obesity)
- Polycystic ovarian syndrome (PCOS)
- Thyroid gland disorders
- Tumors on the ovaries or brain (rare)
- Chemo and radiation treatments for cancer
- Uterine scarring
If you've had your uterus or ovaries removed, you will also stop menstruating.
Amenorrhea Diagnosis
Because many things can cause amenorrhea, it may take time to find the exact cause.
Your doctor will first take your medical history and give you a physical and pelvic exam. If you’re sexually active, they might first order a pregnancy test to rule out pregnancy as a cause.
It may take several kinds of tests to find out what’s causing your amenorrhea. Your doctor may use one or more of the following:
Blood tests. These measure the levels of certain hormones in your blood, including follicle-stimulating hormone (FSH), thyroid-stimulating hormone, prolactin, and male hormones. Too much or too little of these hormones can interfere with the menstrual cycle.
Imaging tests. These tests can show abnormalities of your reproductive organs or the location of tumors. The tests include ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI).
Hormone challenge test. Your doctor will give you a hormonal medication that should cause menstrual bleeding when you stop taking it. If you don’t, this can mean that a lack of estrogen is behind your amenorrhea.
Hysteroscopy. Your doctor will put a small lighted camera through your vagina and cervix to look at the inside of your uterus.
Genetic screening. Looks for genetic changes that can stop your ovaries from working, and for X chromosomes that are partly or completely missing (Turner’s syndrome).
Chromosome tests (karyotype). Identifies missing, extra, or rearranged cells in your chromosomes to help pinpoint abnormalities that can cause amenorrhea.
Amenorrhea Treatment and Home Care
Treatment for amenorrhea will focus on the condition that causes it. Hormone replacement therapy or birth control pills can help start your menstrual cycle again. A thyroid or pituitary disorder can be treated with medication. Physical abnormalities may need surgery.
If something such as stress, weight gain or loss, or depression is affecting your menstrual cycle, you can take an active role in your treatment by taking steps to manage it. Friends, family, or your doctor may be able to help you.
You can help your doctor trace the cause of your amenorrhea by tracking changes in your cycle and symptoms and sharing this information with them. Tell them what medications you’re taking, and about changes in your diet, exercise habits, and stress levels.