Amenorrhea 

Amenorrhea is the medical term for absence of menstrual periods. It is abnormal except before puberty, during pregnancy and early breastfeeding, and after menopause. Any woman who misses more than three periods in a year’s time should see a doctor to find the cause.

Causes of amenorrhea
Amenorrhea is called primary if a woman hasn’t started menstruating by age 16 years. Primary amenorrhea is usually due to genetic or reproductive organ problems that are present at birth but not noticed until puberty. Turner syndrome is one example.

Amenorrhea is called secondary if a woman who has had periods in the past loses her period for at least six months.  Pregnancy is the most common cause of secondary amenorrhea. Other common causes are ovarian problems such as polycystic ovary syndrome and early menopause, also called primary ovarian insufficiency (POI) or premature ovarian failure (POF) (see section on Infertility).

Hypothalamic amenorrhea occurs when the hypothalamus in the brain slows or stops releasing GnRH, the hormone that starts the menstrual cycle.  Women typically affected are those with eating disorders or who are athletes, such as ballet dancers, figure skaters, and runners. What they have in common is:

• low body weight
• a low percentage of body fat
• a very low calorie or fat intake
• emotional stress
• strenuous exercise that burns more calories than are taken in through food
• some medical conditions or illnesses

Amenorrhea can also be caused by benign tumors in the pituitary gland, obesity, polycystic ovary syndrome, and adrenal gland disorders.  (The adrenals are two small glands located above each kidney that produce some sex hormones.) 

Treatment
Treatment of amenorrhea varies depending on the cause. It could involve changes in lifestyle—such as gaining or losing weight, exercising less intensely, or reducing stress—medication, surgery to correct abnormalities in reproductive organs, or a combination of approaches. Treatment with birth control pills is used to regulate periods for some women. These medications, which combine estrogen and progesterone, maintain balanced levels of the hormones in the body.

Prolonged amenorrhea increases the risk of bone loss, so taking calcium and vitamin D supplements is recommended.  Women with hypothalamic amenorrhea also need to gain weight or correct other underlying problems to keep their bones strong.