Amenorrhea

What is amenorrhea?

Amenorrhea is the term used when a woman or adolescent girl is not having menstrual periods. There are two types of amenorrhea:

• Primary amenorrhea: when a girl has not started having menstrual periods by age 15
• Secondary amenorrhea: when a girl or woman has been having menstrual periods but then stops having them for at least three months

What other symptoms may be associated with secondary amenorrhea? 

Other associated symptoms vary according to the cause. Primary ovarian insufficiency can cause hot flashes and vaginal dryness. An elevated prolactin level can lead to discharge of milk from the nipples. A pituitary tumor can result in headaches and vision changes. Polycystic ovary syndrome can cause acne and hair growth on the face and body. Many women have no symptoms other than the lack of menstrual periods.

What causes secondary amenorrhea?

Women naturally stop menstruating during pregnancy, long-term breastfeeding, and menopause. Birth control pills and injections and hormone-containing IUDs cause amenorrhea in some women. A number of other conditions can cause secondary amenorrhea.

Conditions that Cause Absent Periods

Primary ovarian insufficiency, also called premature ovarian failure (menopause before age 40) can be caused by:

• Abnormal chromosomes
• Immune disorders
• Damage to the ovaries from chemotherapy or radiation

Long-term lack of ovulation (release of an egg from the ovary) due to disorders of the hypothalamus can be caused by:

• Mental stress
• Weight loss and low body weight
• Eating disorders such as anorexia
• Excessive exercise
• Tumor of the hypothalamus
• Radiation or other damage to the hypothalamus 

Long-term lack of ovulation due to disorders of the pituitary can be caused by:

• Increased prolactin secretion from the pituitary 
• Tumor of the pituitary
• Radiation or other damage to the hypothalamus 

Abnormal balance of other hormones

• Polycystic ovary syndrome
• Adrenal or thyroid gland disorders

Scarring of the uterus

• Some uterine procedures, such as dilation and curettage (D & C)
• Infection

How is secondary amenorrhea diagnosed?

Your doctor will ask questions about your medical history and do a physical exam. You will have a pregnancy test. Your doctor will likely order blood tests to check levels of FSH, estradiol, TSH, and prolactin. Blood tests also can measure androgen levels and check for thyroid or adrenal gland disorders. 

If you are diagnosed with primary ovarian insufficiency , your doctor may check your chromosomes to see if a genetic abnormality is the cause. If your doctor thinks you may have a problem with your pituitary gland or hypothalamus, you will have an MRI, a brain imaging test. Some also have imaging tests of their reproductive organs.

What is the treatment for secondary periods?

The treatment depends on the cause of your amenorrhea. Options for treatment include:

• Medicines that help control abnormal hormone levels
• Surgery for tumors of the pituitary, ovaries, or adrenal glands
• Counseling about how to eat a balanced diet, keep a healthy weight, and cope with stress

Your doctor might also prescribe estrogen therapy to relieve hot flashes and vaginal dryness and to protect your bones. Calcium and vitamin D supplements, along with strength training, also help keep your bones strong. If you are trying to get pregnant, other treatments might be needed.

What should you do if you’re worried about absent menstrual periods?

If you haven’t had your period for more than three months, see your doctor. Most causes of secondary amenorrhea can be detected easily and treated successfully.

Questions to ask your doctor

• What is the main cause of my absent menstrual periods
• What are my treatment options?
• What are the pros and cons of each of my treatment options?
• Should I see an endocrinologist for my condition?